Wednesday, November 13, 2013

Out with the Old in with the New: Not so much. Diagnosing Fibromyalgia






There has been a great deal of criticism regarding the 2010 Preliminary Proposed Criteria for Fibromyalgia, here, and The Modification of the American College of Rheumatology, here. Besides my own concerns reported on in a blog titled A Comprehensive Review on the Proposed and Modified Diagnostics for Fibromyalgia, hereyou might be interested in seeing what other clinicians an researchers have to say:
 


  • Enhancing the Diagnosis and Assessment of Fibromyalgia by Lesley M. Arnold, MD, here.
  • A report and opinion on the preliminary guidelines for the  clinical diagnostic criteria for fibromyalgia by Robert Bennett, MD, here.
  • Drs Bennett & Clauw Debate Abandonment of Tender Point Test in Revised FM Diagnostic Criteria, here.
  • The Scientific Basis for Understanding Pain in Fibromyalgia by Robert Bennett MD, FRCP, here
 
In July of 2012, the SSA ruled to include Fibromyalgia in the listing of impairments, here. As an RN, this expert  was thrilled that the SSA has the good sense to use the 1990 criteria and require a physical exam, something the authors of the new criteria say is not necessary. As always, functional impairment must be documented using tools such the Residual Functional Capacity Questionnaire by Dr. Robert Bennett. The new diagnostic criteria, proposed but in use by some, falls short of assessing patients for clinical trials and in helping them obtain disability benefits. You can read more about pain and disability here
 
Many study results are skewed because common comorbid conditions are not ruled out, the number one culprit is myofascial pain syndrome (MPS), which is known as the great imitator. Research suggests it is one of the main peripheral pain generators to the centralization (amplification) of pain in fibromyalgia. It is also prevalent in other overlapping conditions, such as bruxism, restless leg syndrome, migraine, bladder and bowel dysfunction, chronic fatigue syndrome, TMJ and piriformis syndrome. The presence of MPS can also explain some of the unexplained symptoms of swelling and neuropathy. This is exactly the type of comment I submitted to the FDA on the upcoming “Public Meeting on Fibromyalgia Patient-Focused Drug Development” on December 10, 2013, here
 
There is no doubt that fibromyalgia may play a role in neuro, endocrine, and immune function because of the upset in the command center of the brain and possibly a broken mechanism in the brain for interpreting pain messages, but to get clear untainted research, we need good diagnostic criteria, which will only come about when all these other things are considered and leaving out a physical exam is no way to go about it.
 
Is it any wonder we seem to be chasing the monkey around the barrel?


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All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com


Thursday, November 7, 2013

Did you know? – Smoothies, health, and you by Celeste Cooper




When dealing with chronic pain issues, it is sometimes difficult to prepare meals, but here is a healthy breakfast or snack solution if you have a blender.





Ingredients:



Use fresh and/or frozen fruits and vegetables on hand. Keep in mind that for some an anti-inflammatory choice is a smart selection, particularly if you are subject to irritable bladder, GERD or other digestion problems, immune deficiencies or conditions that create inflammation.


Keep it balanced:

Protein powder (or if you are gluten intolerant, use the protein substitute of your choice.

Special considerations:

Apples are considered to be a low acidic fruit in their raw form. They are abundant in pectin, a natural substance that soothes the stomach and absorbs acid, so they are actually creating an alkaline environment when digested.  They are a great source of vitamin C, and have phosphorous, iron, antioxidants and flavanoids, and they are high in fiber. 

“An apple a day keeps the doctor away.”

Because apples are high in fiber, they are also a good choice for those of us who take medications that cause constipation or experience alternating constipative/diarrhea irritable bowel syndrome.

Tip! The peeling of an apple is important too, but it is also a great source of accumulated pesticides. Therefore, wash your apple (or other fruits and vegetables with edible peelings) by sprinkling on some baking soda, wet your hands and massage the apple, then rinse thoroughly.

Want to know more about flavanoids?  They are discussed in “Summer Devotions” and nutrition tracking is discussed in the “Fall Devotions” of Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain. Many tracking tools are included in Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: the Mind-Body Connection. You can read more “About the Books” at http://TheseThree.com

Did you know?

Did you know that you can freeze a whole banana and use it later? Yes, it is true, and you can cut off what you need and easily remove the peeling. Not only do they add flavor, a banana also adds fiber, protein, vitamin B6, vitamin C, potassium, manganese, magnesium, folate, riboflavin, niacin, vitamin A, and iron. There is a reason they are considered as a baby’s first food.

Green leafy vegetables, such as spinach, broccoli, kale, red (my personal favorite) and green romaine lettuce, are packed with fiber and are a great source of vitamins and minerals.
The more colorful the better, because bright colors mean they are loaded with antioxidants, which fight cellular oxidative stress apparent in both fibromyalgia and CFS/ME.

Carrots are known as the eye health veggie. Raw carrots are loaded with fiber and a great source of thiamin, niacin, vitamin B6, Folate, manganese, vitamin A, vitamin C, vitamin K and potassium.

Tip! Cleaning vegetables with a weak vinegar solution will help fight any lingering bacteria.

If you have left over colorful bell peppers, zucchini, cucumbers, etc., throw those in too. Any colorful fruit or vegetable that your body tolerates is a good choice.

*If you are sticking to a low acid forming diet, check to see if ingredients are “acid forming” foods. They can be acidic, but that does not mean they create an acidic environment in your body.  This topic is outside the source of this particular blog. 


I have found by using fresh and frozen fruits and vegetables it makes the smoothie like drinking a nutritious shake. Add water, milk, almond milk, soy milk, whichever you prefer, for the consistency you like and enjoy vitamins the old fashion way with a modern twist!

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All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com

Saturday, October 26, 2013

Caricature Contest Winner!


We have a winner for the chronic pain self drawing contest!

Congratulations go to 

DRUM ROLL 

Jen Jasper



Jen will have her drawing published in Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain, Winter Devotions due out the first part of December, and she will get a signed copy of the book.

Thank you to everyone who participated, those who shared a piece of themselves with me and with others, and to all those who took the time vote. The support we give one another is necessary for each of us to battle the consequences of chronic pain.


“You never know what's around the corner. It could be everything. Or it could be nothing. 
You keep putting one foot in front of the other, 
and then one day you look back and you've climbed a mountain.” 
― Tom Hiddleston


In healing and hope, Celeste

You can read more about the two books already published in the series here.

Saturday, October 19, 2013

Celeste Cooper's Interview with Dr Wangen, IBS specialist


It is the opinion of this interviewer, Celeste Cooper, RN, that irritable bowel syndrome is a comorbid condition to many immune disorders. In my interview with Dr. Wangen, I found what he had to say very interesting, and I think you will too.

Dr. Stephen Wangen, ND and the IBS Treatment Center have a mission to provide the best care possible for irritable bowel syndrome. He says, “You not only look at symptoms, you have to look for the cause of the problem and, most drugs are only designed to treat symptoms.”

So Dr. Wangen:

How do you determine need?
Anyone suffering from a digestive problem needs to seek help from someone who is focused on solving IBS. Digestive problems should not be unpredictable. In fact, they shouldn't happen at all except on rare occasions.

Can you share a few of the causes you have found in IBS?
There are so many causes. One of the advantages of specializing in this area is the ability to sort through those and determine which are relevant for each patient. The digestive tract is a fascinating ecosystem that contains 100 trillion bacteria and a majority of our immune system. The health of this environment plays a role in the development of food intolerances, food allergies, and food sensitivities, all of which must be assessed. It also is impacted by everything we ingest, and it has the potential to be affected by yeast overgrowth (Candida), parasites, and even stress.  All of these play a role in leaky gut syndrome, which is another aspect of digestive health. I have seen patients with food allergies that they never even imagined possible, such as to cane sugar, and people with yeast or parasites that had been completely missed. But most patients have several factors negatively affecting their digestion all at the same time. That is why it is often challenging to figure out by yourself.

Why did you decide to start a center based solely on treatment of IBS?
I once suffered from IBS. When I saw doctors, they had no idea why I had my symptoms. They made guesses and nothing helped. I was told that it was stress and labeled it as IBS. That didn't leave me with any more knowledge than when I first started. I already knew that my bowel irritated me. As I began to see patients, I became more focused on finding the cause of digestive problems, and then I became more successful at helping patients. Ironically, it usually isn’t stress that causes the problem, but IBS that causes the stress!

How many patients do you see with IBS?
I've seen around 4,000 IBS patients.

What is your most difficult type of IBS to treat?
There are many different types of IBS, but they all involve one or more of the following symptoms: diarrhea, constipation, abdominal pain, gas, or bloating. I can't say that one is more complicated than the other. The symptoms only tell me that something is wrong.

As a naturopathic doctor, do you use integrative therapies such as, manual therapies, acupuncture, trigger point therapies, meditation, or nutritional changes?
My goal has always been to solve IBS, not adhere to a medical philosophy. All of the things that you mentioned have value, sometimes even prescription medications. However, all of these treatment modalities are a lot more effective when used in the right ways for right person by assessing each patient individually.

At the IBS Treatment Center, we focus on trying to find the cause of the problem. There are many assessment tools including unique labs for testing the environment of the bowel and its effect on the body. They are not all created equal. We test the labs, use different labs in different situations, and we apply various treatments based on what works best for each individual.

Can you tell us a bit more about what you are looking for with lab results?
Lab results help us develop our priorities. A good lab will properly identify the correct food intolerance, for example. And a highly specialized parasite lab will find parasites that other labs miss. However, even lab work has its limitations. Many aspects of what we do have come from years of clinical experience. Sometimes experience and listening to your patient is more valuable than lab work. We combine both to get the best results possible.

What can the patient expect as an active participant in the treatment protocol?
Anyone who thinks that health can be handed to you from someone else is gravely mistaken. Patients often need to make dietary changes, but these are targeted changes based on each patient’s lab results. If patients are willing to participate in their plan, they have a very good chance of getting better.

Do you consider gluten to be an irritant to the bowel and do you feel this is true for ALL IBS patients?
Gluten intolerance is just one of many possible irritants involved in IBS.  It may or may not be a factor for an individual. Determination is based on what we find with the patient’s lab results.

An anti-inflammatory diet is suggested for arthritis and autoimmune disorders. What are your thoughts on suggesting it for IBS patients?
Inflammation is produced by the immune system and the immune system must be triggered to turn it on. Different foods will turn on inflammation in different people. A successful anti-inflammatory diet is about identifying the specific triggers in each individual. There is no one size fits all anti-inflammatory diet, but there is an anti-inflammatory diet for each patient.

In general, what is the easiest to overcome and what is the most difficult? (ie. infrequent attacks vs IBS and bowel disease).
Inflammatory bowel disease (IBD), which is very different from IBS, is often the most difficult, but even then we have good success.

You don’t feel patients with IBS and bowel diseases such as Crohn’s disease or diverticulosis have more difficulty controlling incontinence or increased bowel motility?
All of these diagnoses -- IBS, Crohn's disease, and even diverticulosis, include a wide spectrum when it comes to the severity of the symptoms that can be experienced. Even though each diagnosis is different with regard to the underlying damage that has occurred, some people have relatively mild symptoms, and others are in the hospital. This is even true for IBS. Therefore, I don't like to underestimate one person's problems just because they don't have a diagnosis that the medical community considers as serious as another.  I try not to judge my patients or predetermine who can get better. Everyone should have hope that they can heal, because they usually can. 

How long does it take for your protocol to work?
Every patient has different components that we are treating, so it varies. Healing is like putting together a puzzle. There is usually more than one piece to the puzzle, and every puzzle is different. In general we should be seeing improvement within about a month after implementing treatment and continuing over the next several weeks. Some patients heal quickly, and others take longer, but the goal is to get them moving in the right direction and then keep them on that path.

I understand that treatment is individualized, but what are your general thoughts on probiotics?
The good bacteria in your digestive ecosystem are critical to digestive health. But not everyone needs probiotics, and probiotics are certainly not all created equal. I like to assess the bacterial environment before I even recommend probiotics, because there are some people who feel worse when they take probiotics and others who are just wasting money taking them. However, when I do recommend probiotics I usually use a full spectrum probiotic that contains as many different species as possible.

What can the patients, who are proactive in their role, hope to achieve? 
Patients should expect a significant improvement in their health. I think that people often let the medical system off the hook too easily. If you take your car into the mechanic and they tell you that they can't fix it, then you find someone who can.  Our goal is to help people get better. Sometimes the most difficult aspect is getting the patient to believe that improvement is possible. If every other highly respected expert is telling you that there is nothing that you can do, then you start to believe it. Unfortunately we're not perfect, but we have a great deal more to offer than most people are getting elsewhere. It's what makes my job so rewarding!

About Dr Stphen Wangen
Dr Stephen Wangen is the co-founder and Medical Director of the IBS Treatment Center. He is a board certified and licensed physician with a doctoral degree in naturopathic medicine from Bastyr University. Dr. Wangen is the author of two books, “The Irritable Bowel Syndrome Solution,” and “Healthier Without Wheat: A New Understanding of Wheat Allergies, Celiac Disease, and Non-Celiac Gluten Intolerance.” Dr. Wangen is also a clinical faculty member of Bastyr University and the Research Director of the Food Allergy and Intolerance Foundation. He may be reached in the Seattle office or by email at info@ibstreatmentcenter.com and on Facebook at www.facebook.com/ibstreatmentcenter

If you live in the Seattle, Washington or Santa Monica, California areas you can call them at:
206-264-1111 (Seattle) or 310-319-1500 (Santa Monica).
You can learn more about Dr. Wangen and the IBS Treatment Center and the individual care they provide at www.IBSTreatmentCenter.com

Post interview remark
It was a pleasure to do this interview with Dr. Wangen and inspiring to know there are doctors who treat IBS patients comprehensively. Naturopathic doctors are not all created equal, and this one had me at “our goal is to improve patient outcome, based on the individual patient.”  There is no cookie cutter answer to managing IBS, and it is refreshing to speak with a healthcare provider that understands how IBS affects a patient’s quality of life, then sets about improving it.

Related articles:

What is Irritable Bowel Syndrome? By Celeste Cooper, here.
Coming Clean on a Dirty Secret, Irritable Bowel Syndrome by Celeste Cooper, here.
            As Fibromyalgia Expert on Sharecare, here.
SIBO, Yeast & Leaky Gut and YOU! here

Wednesday, October 16, 2013

Top Three self pain caricatures - Vote now!



Vote for your favorite Self Caricature – The Top Three have arrived – Instructions following.

The top three were chosen by an independent party who is well versed in the benefits of self drawings. 


3201


4202

5406


NOW THE VOTING BEGINS
And ends on October 25th


Where do I vote?

Follow the following link to Celeste Alewel-Cox Cooper note titled “Caricature Contest 

(Click)


How do I vote?
  • Use the number you see under the drawing for your vote, 3201, 4202, or 5406.
  • Follow the above link and click the comment tab below the note you find there and enter the number for the drawing of your choice. 


Vote  until October 25, 2013

The WINNER will be announced on October 26, 2013, and they will have their drawing published in the Winter Devotions of the Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain series and receive a signed copy of the paperback edition.


A huge THANK YOU to everyone who submitted their drawing. Every one you expressed a personal pain experience that connection with me through your drawing.  Many of you told me you found the exercise very cathartic.  A picture says a thousand words and you are all winners to me.



Friday, October 11, 2013

October is Physical Therapy and Massage Awareness Month: Focus, Trigger Points and Myofascial Pain Therapy



The Physical Therapist

Not all physical therapists are created equal.  If you suspect you have myofascial triggerpoints (MTrPs) or myofascial pain syndrome (MPS), it is extremely important that you do some investigating before you ask your physician for a referral.  A physical therapist that understands the myofascia, what trigger points are, and what they can do is imperative.  The specially trained physical therapist may or may not be one who specializes in sports injury, but they should be educated about myofasical pain syndrome.  If they are specially trained, they can offer active release therapy, myofascial release, or other muscle targeted therapies and education to help you get you back on the road of recovery.

The Massage Therapist or Body Worker

There are many types of massage used for different reasons and massage is gaining favor as a therapeutic intervention for those with chronic pain.  Because there is one particular problem that is inherent in most if not all chronic pain conditions, we are focusing on trigger point massage. A good MTrP therapist or body worker understands the work of the pioneers in myofascial medicine, Dr. Janet Travell, and Dr. David Simons. You might be able to find one who is part of the NAMTP (NationalAssociation of Myofascial Trigger Point Therapists)  or ask for a referral from an integrative pain specialist in your area.  Before you make an appointment you should first ask, “Do you have, or are you, trained in the work of Travell and Simons.”

Experts tell us that to get the most benefit, it is important to learn how to do self therapy between professional sessions. Your physical therapist, specially trained massage therapist, or body worker, and even some integrative pain specialists can show you how to do this or make referrals to materials that teach you.

If you have had a long standing history of MPS, and trigger points that have been neglected, it will take perpetual work to get and keep myofascial trigger points under control, but don’t give up.

So, what is a trigger point?

Trigger points are knotted up muscle fibers in a taut band of muscle. They are EASILY felt unless behind bone or other muscles, or the band of muscle affected is too tight, in which case "specific myofascial therapy," must be used to loosen up the taut band of muscle in order to isolate the specific myofascial trigger point (MTrP) causing pain, dysfunction and radiation of symptoms in a specific pattern associated with that specific MTrP.

Common Abbreviations© 

  • MPS: myofascial pain syndrome 
  • CMP: chronic myofascial pain
  • MTP: myofascial trigger point 
  • TrP: trigger point 
  •  From Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection by Celeste Cooper, RN and Jeffrey Miller PhD


What do MTrPs do?

Myofascial trigger points can mimic many things and cause pain, dysfunction, and shortening of the muscle affected by this knotted up muscle fiber. Numbness and tingling, burning, certainly pain, can all result from a MTrP which is entrapping a nerve. These symptoms can be local or radiate in a specific pattern that remains consistent among all patients. Circulation/temp changes can occur if MTrPs are located next to a blood vessel, and swelling can develop if the MTrP is located next to a blood or lymph vessel).

You can learn more detailed information about trigger points and myofascial pain syndrome on my website here

What is Myofascial Pain Syndrome?

The development of trigger points can occur from usual muscle strain or injury, surely you or someone you know has woken up with a “crick” in their neck.  Generally, these are isolated events that can be easily and successfully treated. But, when trigger points start to develop in all four quadrants of the body, and they persist for over three months, it is important to consider the existence of myofascial pain syndrome.  Myofascial pain syndrome has been found in many if not most chronic pain conditions, including but not limited to, fibromyalgia and chronic fatigue/myalgic encephalomyelitis, migraine, spinal degeneration, teeth grinding, restless leg syndrome, TMJ, interstitial cystitis, irritable bladder, arthritic joints, and can result from post surgical scaring. When not treated by a therapist who understands the work of Travell and Simons, the patient does not get any lasting relief.

The pain that exists because of trigger points depend upon the location of trigger points and you can refer to the links following to decide if you need to know more about trigger points and how they can affect the body and various diseases.

There are many dedicated physical therapists and myofascial body workers that dedicate their lives to helping you.  Many times the therapies they use to treat you can put them at risk for developing myofascial issues, whether they work specifically with the myofascia or not. So please take the time this month to tell them thank you.

Following are few articles written with you in mind:



You can learn more about trigger points and myofascial pain syndrome, including various treatments known to help in “Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection.” Available from our publisher Healing Arts Press and Imprint of  INNER TRADITIONS, Bear and Company here, Amazon here,  Barnes and Nobel, here, and other major retailers. It is also available in Kindle and Nook.

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All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com


Wednesday, October 2, 2013

October Awareness launches with World Smile Day on October 3rd by Celeste Cooper


October welcomes us to recognition of:

  • October 3rd is World Smile Day  
  • Dysautonomia
  • Physical Therapy
  • Massage Therapy


Let’s start with October 3rd 

WORLD SMILE DAY



Put this on your mirror; don’t miss a wonderful opportunity to smile with the rest of the world on Thursday.

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Coming in the Winter Devotions of Broken Body, Wounded Spirit: Balancing the See-Saw of Chronic Pain series.

Ten rules for an inspirational life:
 #1 - Stop negative self talk.
#2 - Smile at someone and yourself every day.
#3 - Tell somebody, even a pet, you love them….

Don’t let it stop here. Make a goofy face at yourself, take a selfie and share it with everyone in your contact list so you can spread the word. Watch and listen for the difference it makes in your own self dialogue ….. SMILE!


“If I can see pain in your eyes then share with me your tears. 
If I can see joy in your eyes then share with me your smile.”
― Santosh Kalwar


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Advocacy for Pain Awareness Month. Looking back, making the most of the present, and using both to move forward.

September is Pain Awareness Month – See what this advocate is doing



~ • ~ • ~ • ~ • ~ • ~

All answers and blogs are based on the author's opinions and writing and are not meant to replace medical advice.  

Celeste Cooper is a retired RN, educator, fibromyalgia patient, and lead author of the Broken Body Wounded Spirit: Balancing the See Saw of Chronic Pain devotional series (coauthor, Jeff Miller PhD), and Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome and Myofascial Pain: The Mind-Body Connection (coauthor, Jeff Miller PhD) She is a fibromyalgia expert for Dr. Oz, et al., at Sharecare.com, here, and she advocates for all chronic pain patients as a participant in the Pain Action Alliance to Implement a National Strategy, here. You can read more educational information and about her books on her website, http://TheseThree.com


Celeste's Website

Celeste's Website
Click on the picture