English paper #2

Dottie George

Prof. Ryterband

English 3A-01

19 September 2019

Fibromyalgia

Fibromyalgia is an autoimmune disease that affects millions of Americans. How a person gets this disease is widely debated. Many people don’t believe fibromyalgia is real; others know it’s real because they have it. Some doctors think fibromyalgia can only be managed, keeping progression at a slower pace. Other doctors believe fibromyalgia can be treated, allowing for a semi-functional life. Then there are a few doctors who believe it can be cured, giving patients the hope of returning to the quality of life they had before fibromyalgia invaded their lives.

What is fibromyalgia? “Fibromyalgia feels different to everyone” writes Dr. David Dryland (Dryland 6). The most common symptoms include, but are not limited to “widespread pain, fatigue, stiffness, restless sleep, pain exacerbated by exercise, non-inflammatory pain that doesn’t respond to medication, increased sensitivity to allergens, confusion or difficulty concentrating (often referred to as fibro-fog), headaches, abdominal cramping, numbness, easily irritated skin, sensitivity to temperature, sensitivity to bright lights or loud noises, sensitivity to intense taste or smells, skin that readily flushes, and discomfort in crowds” (Dryland 8).

The most common way to diagnose fibromyalgia is to eliminate the possibility of other, diagnosable diseases: lupus, multiple sclerosis, chronic fatigue syndrome, Lyme disease, rheumatoid arthritis, hypothyroidism, neuropathy, chronic myofascial pain syndrome, dementia, irritable bowel syndrome (Dryland 66-78).  Since fibromyalgia is diagnosed by the elimination of other diseases, to some it is considered the diagnosis one gets when there is nothing diagnosably wrong with a person. For that reason, many believe fibromyalgia is not real and is “just in your head.”

According to the News Medical Life Sciences article “History of Fibromyalgia”, fibromyalgia is a “condition that has been known to mankind since the 1800s . . . They called it muscular rheumatism . . .  In 1987 fibromyalgia was first recognized by the American Medical Association (AMA) as a defined disease entity and cause of illness and disability.” Fibromyalgia-like symptoms were first described by Hippocrates in 400 BC (Dryland 9).

When a person is diagnosed with fibromyalgia, there is a mix of emotions. First comes relief, because whatever they have been suffering with finally has a name.  But often that relief is short-lived, and quickly replaced with many questions. Can it be treated? Can it be cured? Is this as good as I am going to be ever? Is it going to get worse? Is there any hope?

Many doctors believe fibromyalgia can only be managed. They think it will only get worse and all they can do is help their patients endure, trying to make life less miserable for them.  The most common medicinal treatments for fibromyalgia are antidepressants and muscle relaxers. Some of the medications given to treat fibromyalgia are given for “off label” usage (David Zelman), meaning the drug is not given for the purpose for which it was created. The side effects help the patient, or through the use of a medicine for another problem, it has been discovered that it might help fibromyalgia sufferers.  Unfortunately, using medication as the primary way to treat fibromyalgia often seems to make life more difficult for the patient. Often the medication can cause weight gain, which is difficult to stop or lose. A patient with fibromyalgia needs to remain as active as possible, but when one gains weight, activity becomes harder and more painful; an individual may become less active which can lead to more weight gain. This starts a vicious downward cycle in the health of the patient, leading to more feelings of discouragement and even depression, which then can lead to more medication.

Dr. R. Paul St. Amand is one of the first doctors to develop a protocol he believed would reverse fibromyalgia.  Having fibromyalgia himself, what worked for him is what he recommended for his patients. 

 St. Amand’s path to healing is based on his belief that the pain of fibromyalgia is caused by phosphate deposits throughout the body between the myofascial tissue and the bone. “Myofascial tissue is a type of thin, strong, fibrous connective tissue that extends throughout your body to provide support and protection to your muscles and bones” (Martin). Dr. St. Amand believes removing these excess phosphate deposits will reverse the symptoms.  He discovered through the treatment of gout patients that the use of guaifenesin can break down these phosphate deposits.  “Guaifenesin is most commonly used to treat coughs. It works by loosening the mucus in your lungs when you have chest congestion due to colds, flu, or allergies.” (Richards). 

St. Amand’s approach helps but is difficult to follow and have success.  Not only does one need to take large amounts of guaifenesin, which is expensive and not covered by insurance, but the guaifenesin can easily be blocked in the system of the one taking it.  If one chooses to take guaifenesin, he or she must give up all contact with salicylates. “Salicylates are a group of chemicals derived from salicylic acid. They are found naturally in certain foods and also synthetically produced for use in products like aspirin, toothpaste, and food preservatives” (Jullian Kubala). Salicylates can be very difficult to avoid, and one can go months without realizing they are blocking the effectiveness of the guaifenesin. Also, the guaifenesin, because of the way it works, causes what feels like flare-ups of the fibromyalgia symptoms (“fibro-flare” or “flare”). The only indication the patient has that they are improving is that they are having “flare” episodes, which may get more intense, but hopefully farther apart. If the guaifenesin is being blocked, the discouragement can be great if the patient thinks they are improving, but really were getting worse.

In more recent years, many more physicians have come to understand more about fibromyalgia and how to treat it. Some doctors have found that their patients achieve great success following an individualized protocol.  Since every patient is different, not only one protocol works for every patient.  Dr. David Dryland (a rheumatologist in Medford, Oregon) believes fibromyalgia can be cured. He believes one of the primary causes of fibromyalgia is an overactive adrenaline (“fight or flight”) response in the body which causes a diminished dopamine supply. Dopamine and adrenaline are key chemicals the body uses to function (Dryland 20). The body normally replenishes dopamine while we sleep.  Without restorative sleep, dopamine production doesn’t keep up with the increased demands of an overactive “Fight or flight” response. A decreased supply of dopamine creates hypersensitivity to pain and other sensations (Dryland 28).

Initially stress will activate the ‘fight or flight” reaction, causing lack of sleep which will increase or initiate pain. The pain will interrupt sleep with the stimulation of the “fight or flight” response. Thus “fibromyalgia becomes self-perpetuating, creating a vicious cycle that is hard to escape (Dryland 29).

At an appointment in 2015, Dr. Dryland described his protocol as working like the legs on a table. “One needs all the legs to be to be balanced in order for the table to be strong, able to do its job.” (David Dryland) He recommends sleep aids to help his patients achieve a regular sleep pattern, so they can get the rest they need in order for their bodies to produce the dopamine they need.  If a patient still has trouble with dopamine production, he will, for a short time, prescribe a medication like Mirapex “as one step of many along the road to recovery” (Dryland 234). 

Dryland understands that fibromyalgia has many triggers and encourages his patients to learn how to function in healthy ways to calm all of the triggers.  In his book he offers advice on how to deal with stress, teaching his patients how to retrain their brain on what kind of situation should trigger the “fight or flight” response and what should not. He recommends his patients find some kind of exercise, understanding that fibromyalgia patients can have a very hard time finding a successful type or routine in exercise (Dryland 197). Movement is key to keeping fibromyalgia patients active, and exercise is a great stress reliever.  He also encourages his patients to do an elimination diet to discover what foods may be triggering inflammation or “fibro fog” (Dryland 161). The fifth “leg” of his treatment is vitamins and supplements. He gives advice on the ones he believes are most likely to help and explains the best way to take them, what they do and why they work (Dryland 181, 195).The vitamins and other supplements help restore health, so the body can return to creating the adrenalin and dopamine it needs in order to restore itself.  His goal is recovery, so that his patients not only don’t need the drugs anymore, but more importantly, so they can return to happy productive lives. “Most tables only have four legs, but I describe this protocol as a table because, like the legs of a table, these things work together to make one healthy. If one leg isn’t as strong as the others, the table falls.  If each of these elements are not utilized properly, treatment will not work as well” (David Dryland). 

Fibromyalgia is a life changing disease, but it is possible to survive and thrive in spite of it.

 

Works Cited

David Dryland, MD. Interview. Dottie George. November 2015.

David Zelman, MD. What Medicines Treat Fibromyalgia? WebMD 07 September 2017. www.webmd.com/fibromyalgia/guide/medicines-to-treat-fibromyalgia. Accessed 12 September 2019.

Dryland, David. The Fibromyalgia Solution. New York: Grand Central Publishing, 2007. paperback.

Jullian Kubala, MS, RD. Salicylate Sensitivity: Causes, Symptoms and Foods to Avoid. Healthline.com 24 February 2018. www.healthline.com/nutrition/salicylate-sensitivity. Accessed 12 September 2019.

Martin, Dr. Aaron. What Is Mayofascial Tissue? Patch.com 13 March 2013. www.google.com/amp/s/patch.com/iowa/ankeny/amp/15464773/bp--what-is-mayofascial-tissue. Accessed 12 September 2019.

Richards, Karen Lee. The Guaifenesin Protocol For Fibromyalgia. Prohealth.com 1 August 2019. www.prohealth.com/library/the-guaifenesin-protocol-for-fibromyalgia-2-38362. Accessed 12 September 2019.