update and article

[Guest guest]

Dear Friends,

I found this article EXTREMELY interesting.. especially in light

of the fact that I have been dx with sleep apnea and have

been using the CPAP machine since the beginning of December

and it is relieving some of the fibro systems... still have the diabetes

and COPD to deal with.. but it is slightly easier to adjust

to challenges with one component slightly diminished.

It would be interesting for each of you to ask your

" sleeping partner " if you " snore " or seem to " stop breathing "

during the night and, if so, check into the possibility of being

tested for sleep apnea.

Haven't been on the computer much lately. Will try to schedule

more time. My husband took a " forced " early retirement from

his job in Chicago the third week in January and we decided

to leave the area and move to Alabama where we had a mobile

home already set up and ready for us on the property where my

daughter and son-in-love and (7), Brittany (5), and

(3) live. Ed brought me down to Alabama mid February

along with my oxygen and C-Pap equipment and then he and

went back up to Chicago with the Jeep and rented a

truck and towbar: packed up the rest of our belongings and

drove the truck towing the car - while Ed drove the Jeep

back down here.

My daughter had made me an appointment with an internal

med specialist, a pulmonary doctor and a diabetes eye specialist

for March 4. Ed and went with me. What a tiring day!

The eye doctor set the cataract surgery for my right eye for

March 14, and the other two doctors did the required tests and

gave the clearance for surgery. THEN came one week of REST

(in bed) and the then March 25, saw the internal med again and

had the left cataract done March 28th (Helps to have a daughter

who used to be an RN working with the doctor's nurses!!)

So... I can SEE again, however, my STUFF is still not unpacked,

and the combination of the surgeries, my Medicare getting all

screwed up (sorry) and the EXTREME tiredness I've been

experiencing, has been impacting my life, quite severely for

the past few months. I am starting to see a light at the end

of the tunnel (especially since I go Friday for my new POST

Cataract eyeglasses exam!!) AND I just received word on Sat.

that my Medicare is straightened out. Now I have to call all

the doctors, surgery center, anesthesia, oxygen company,

etc and get them to re-file all the claims.. since on COBRA,

Medicare is considered PRIMARY..

To add to the mix, Ed has been helping add an extension

to my daughter's house (to the kitchen by removing the

outside wall to the end of a porch, thereby increasing the

size of the dining area and the cabinet area by 1/3. He

has been over there painting, etc. as well as helping me

with " body maintenance " and cooking, cleaning and

STUFF. I had the kids over a couple of times, but I

am just starting to get my strength back, and THEY

TIRE ME OUT QUICKLY!! Like the curious, active

children they are, they are into everything - un-packed

boxes, etc.

Things are getting much better, though.

Hope to be more involved in the future. Enjoy reading

all the posts, even though I don't respond very often.

May God continue to provide each of us with a measure of

STRENGTH, WISDOM and PEACE.

elaine

Fibromyalgia

Margaret T. , MD

Fibromyalgia is a clinical diagnosis. The disease is characterized by

musculoskeletal pain and diffuse tender points. Frequently the patients have

associated sleep disorder and fatigue. They also have some organ-specific

manifestations that are functional in nature. It has actually been described

as far back as the 1700's, but really I'd say in the late 70's until now it

has become a very prominent diagnosis from a medical standpoint, from a work

disability standpoint, and from a medical/legal standpoint because it's such

a nebulous area.

Fibromyalgia was eventually used over the older term, fibrositis because

there really is no evidence of an inflammatory component. The triggering

event is some sort of disruption of sleep which leads to poor rest at night,

so you have non-restorative sleep which leads to fatigue, and also

presumably the muscles also need to relax. If they don't, there is muscle

pain and that leads to lack of activity. Patients become de-conditioned and

poor conditions maybe further begets pain and the pain then, as a sort of

positive feedback cycle, disrupts the sleep. Whatever causes it, you get

this vicious cycle of muscle pain, fatigue and sleep disorder. People have

tried to look at various neurohormonal chemicals, such as insulin-like

growth factor 1 was hot for awhile, substance P in the cerebral spinal

fluid, serotonin is probably the thing that people latch onto most because

we use drugs that affect CNS serotonin metabolism and they seem to help. So

maybe there is something in that. Also there may be a predisposition. No

genetic component has been found yet but I always wonder, do the patients

have some sort of premorbid personality that maybe makes it more likely for

them to develop fibromyalgia? Unfortunately, every patient I ever asked

says, " Oh, before I got sick I was fine, energetic, working hard. " And often

they are but I haven't found anything very distinctive in just my cursory

evaluation of patients.

I still believe that something that disrupts the sleep can then lead to the

symptoms of fibromyalgia. This was taken from the original studies by

Moldofsky and this is normal non-REM sleep, or stage IV delta sleep. It's

the real deep sleep when you are almost comatose. I mean someone could kind

of come in and remove a digit and you wouldn't know. You can see it has

these slow delta waves, rather large. This is fibromyalgia sleep pattern.

This is what this gentleman found and you can see that there is the delta

sleep, which is these larger waves, but you can see how it looks very choppy

because there's what they call alpha intrusion. There's an alpha pattern

superimposed on the delta pattern. The alpha pattern is what happens when

you are awake. Presumably your brain is a little more active. If you take a

healthy person and then give them some stimulus, try to wake them up, you

can see what happens. You have the normal delta pattern and the all of a

sudden you have this alpha intrusion. This is the fibromyalgia patient

without any stimulus. It's almost like they are not really sleeping. Again,

this has not been able to be confirmed in further studies by other groups,

whether it was how it was done or the patient selection, is not really

clear. I think if you think of fibromyalgia with this diagram in mind it

might help you a little bit when you see the patients. It's not going to get

you out of the office any quicker, believe me. Sometimes I see these

patients and I think, " I could be having my spleen removed with a warm spoon

instead of . " These patients are very trying. I'll see three or four new

fibromyalgia patients in a day, I come home and by 7 o'clock I'm in bed. I'

ve had it. And I usually stay up until 12 or 1 o'clock reading, doing work,

watching the football game - which is usually about when it ends - so these

patients really do wear you down. It's almost like they are doing it on

purpose.

But you can see that the central item is the stage IV sleep anomaly which

most often, in my experience, you can't find an identifiable cause but

sometimes there are things that cause it. Someone who has muscle or joint

pain, someone who has had some physical trauma. Emotional trauma obviously

can cause it. Sleep apnea. But these aren't the things that I usually see in

my practice. In general practice you may see these things sometimes. I

remember a case - it was one of my fellows' patients - who had some upper

airway obstruction, snored a lot and had some sleep apnea and he had

secondary fibromyalgia. When he went to the sleep center they gave him this

C-Pak at night and his fibromyalgia, over a period of a few weeks, cleared.

So occasionally if you can find an underlying cause you may be able to treat

the patient specifically

http://www.medical-library.org/journals/secure/rheumatology_81100/fibromyalg

ia_syndrome.htm