FIBROMYALGIA
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Fibromyalgia Perspective
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Dr. Robert J. Langone, D.C.
Fibromyalgia Everything you know and everything you’ve tried has brought you to where you are and how you feelright now. Our mission is to help you take the next step. Most likely, this is not your first attempt to understand fibromyalgia and help yourself or someone you care about to feel better. In visiting other websites, reading books, pamphlets, or literature, you will find the majority of information revolves around symptoms; pain, tenderness, fatigue, poor sleep, digestive problems, brainfog and depression. Dr. Langone has found that most information from these sources, as well as information from your doctor about fibromyalgia, does little to help a patient put fibromyalgia, and the real-life challenge of dealing with fibromyalgia, into perspective. Consequently, patients search and search and search, but never feel as though they have gotten anywhere. We will share with you cutting edge research and a fresh, realistic perspective of fibromyalgia and fibromyalgia-like conditions based on Dr. Langone’s research, experience, and excerpts from his upcoming book, “Fibromyalgia: It’s Not Your Fault.”
PERSPECTIVE Putting Fibromyalgia into Real Life Perspective Putting pain and suffering into perspective is Fibromyalgia 101. Before we do, however, let’s define fibromyalgia through the patient’s eyes. Fibromyalgia, to a sufferer, has been referred to as the “I hurt everywhere” syndrome. This definition seems to work for most and establishes a common ground for discussion. If we go ahead and try to become more technical in our definition, we would first break down the word fibromyalgia per the example of most textbooks: fibro, from the word fiber, describes the soft tissues of the body; my/myo means muscles; and algia is a word used to describe pain. With all its pieces together, the word fibromyalgia, in technical terms, describes pain in the muscles and soft tissues of the body. This definition comes from the American College of Rheumatology and sufficed for most physicians and patients until only recently. For our purposes, however, we strive to find a more accurate definition, reflecting contemporary thinking in the scientific community. To do this, we must first understand how and why we even need a definition. This is the first step in building our perspective. Most recently, fibromyalgia has been termed a Central Sensitivities Syndrome, or CSS.(3) Simply put, CSS occurs when something causes your central nervous system to become overly sensitive. This oversensitivity has the potential to cause a variety of symptoms. When a variety of symptoms exist concurrently, we call it a syndrome. The most commonly reported symptoms of fibromyalgia syndrome are widespread pain, fatigue and poor sleep. I doubt that there is any fibromyalgia patient who would take issue with this concept or definition. We will expand upon CSS further below. Putting pain and suffering into perspective is a crucial part of understanding almost all undesirable human conditions; fibromyalgia of course is our focus. Pain The pain of fibromyalgia is characterized as widespread with tender points. Most commonly, the pain lasts for three months or more, and is experienced above and below the waist, as well as to the right and left of the midline. Frequently, a patient will come to us with a diagnosis of fibromyalgia, and we find that the pain is isolated to the neck/shoulders, or mid back, possibly low back, or buttocks area. This is very likely a subluxation problem, or another musculoskeletal condition, but not fibromyalgia. When describing pain, we are in a world of subjectivity. Pain is only qualified and/or quantified by the perception of the patient. In the past, perception was thought to exist only in the mind and feelings, with no documentable evidence or understanding to measure objectivity. However, we now know that there exists within the brain a very real neurological and chemical mechanism that calculates pain signals and shapes a personal opinion of pain for an individual. We, as humans, have a unique gift (though to some this may be a curse); the ability to create and form opinions. For instance, if you and a friend had flour, water, eggs, herbs, spices, fruit and vegetables, it would be very easy to agree that you have flour, water, eggs, herbs, spices, fruits and vegetables. What these things specifically mean to you, and your perspective of what to do with them, however, is a very personal thing. You might see them as the ingredients in forming an end product, such as a loaf of bread, vegetables, soup and dessert or a salad. You took raw facts and assembled them in your mind, forming an opinion on the best use of these ingredients. Your friend might have a very different opinion on what to do with these ingredients, depending on how his or her mind works. He might see a loaf of bread or a veggie omelet, rolls and a fruit salad. (Personally, I’d make the pizza and save the fruit for table decoration.) Just as all these ingredients could lead us to see a unique end product in our mind, we can all see the “ingredients” that lead to a unique/personal pain experience: for instance, a hammer, 20 lbs. of force, and your left thumb. While one person might feel excruciating pain, tears welling in their eyes and an impending trip to the hospital, another may merely say “ouch” and help themselves to a slice of my aforementioned pizza. The point is that there are endless possibilities of how the nerves and chemicals in the brain can interact to form an interpretation/opinion, and a reaction to any given situation. Although we are gaining understanding of these mechanisms, it is my opinion and interpretation that we will never be able to completely understand each other’s interpretation or experience of pain. Hence, we say pain is subjective: you can feel it, and you can describe it somewhat, but another person will never be able to completely “feel your pain.” We find that pain has been dealt with as if it were purely abstract in nature. In a court of law, pain would be considered hearsay and not admissible as evidence on its own. In a doctor’s office, however, your doctor is the judge of whether the pain you say you feel is admissible. Where there is evidence, your doctor will accept your opinion. Where there is no evidence, your doctor may consider it hearsay and not even believe that you are actually in pain. Unfortunately, some of you have already experienced this rejection. This attitude is of great concern to me. The scientific community, while explaining and accomplishing amazing feats, has stifled our evolution in crucial areas. If feelings or pain cannot be calculated, or consistently qualified and quantified from patient to patient, or from doctor to doctor, it is considered non-scientific. The scary thing is that scientists take themselves so seriously that, throughout history, they have not only considered many people that say they have pain to be nuts, but also considered a practitioner that validates pain without evidence, to border on voodoo or quackery. Unfortunately this is a common theme of evolving science. There is nothing in the universe that is un-scientific; however, there are many things that we do not yet understand. Those things are relegated to subjectivity, so that those who define the paradigm are never wrong. At first glance, we might assume that where there is pain, there is suffering. However, we find that this is not always the case. Suffering Suffering, when noted, is a frustration and embarrassment to the medical community. Suffering inherently suggests an emotional component. For instance, a woman giving birth may feel great pain, but she does not feel as though she is suffering. In “The Nature of Suffering,” EJ Cassell states, “suffering can be defined as the state of severe distress, associated with evidence that threatens the intactness of a person.” We find that if a person has hope, they can rationalize that the pain holds no threat to their intactness. When we have understanding and feel in control, it is very easy for us to rationalize what we are going through; during those times, we may feel severe pain, but never feel as though we have suffered. Fibromyalgia is hard to rationalize, therefore it generally brings pain and suffering. You feel pain due to transmission of signals in your brain, which are interpreted as painful. You suffer because the pain is ongoing, has no rhyme or reason, and you can’t control it. The patient is confused by a lack of understanding; they have a feeling of hopelessness. Certainly, this is a feeling of loss of control, purposeless pain, and severe distress that threatens the intactness of you and your life. Putting pain and suffering into perspective is crucial, for doctor and patient alike, if we are ever to understand fibromyalgia. Why is it that some sufferers seem to cope with fibromyalgia better than others? A reasonable explanation might be interpretation. Everyone’s nervous system interprets signals differently, based on past experience, and the way their brain and central nervous systems are “wired,” per se. Another factor is values and belief systems. They help us to form opinions and create subjective interpretation of pain signals received. Some patients have learned mental and physical exercises that help them to train their brain much in the same way you could train your brain to coordinate the way the tennis racket in your right hand connects with the tennis ball tossed in the air by your left. We can, literally, train our brains to interpret pain signals differently. For example, a patient with a positive attitude may seem to endure pain well, and not be suffering or compromising daily activities. Another may have beliefs that caused them to interpret pain in a way that reduces their ability to cope. A 45-year old woman who came to our clinic expressed that she felt hopeless because she couldn’t feel like she was 16 years old again. She felt as if there was no sense in living. Her beliefs and attitude would sabotage her every effort to feel better. In Unlimited Power, by Tony Robbins, he discusses self sabotage. He talks about a person setting himself up so that it would be difficult to win and reach his goals or objectives. He writes of a seminar he gave where he asked for a show of hands by all those who felt like winners. One man raised his hand and shared with the group that he felt like a winner because he could get up every morning, breathe fresh air, pay all his bills, and get by just fine. Robbins then asked if anyone in the room felt like a loser. Another man raised his hand and said that he felt like a loser because he only made $650,000 the year before. The audience politely laughed, and Robbins asked why on earth this man felt like a loser. The man replied that his goal had been to reach at least the million dollar mark, and when he didn’t, he felt as though he had failed. With a flair of sarcasm, Robbins replied, “Well, $650,000 a year. You can’t live on it, but it’s a start.” The audience roared, and Robbins then pointed out that this man had set himself up to fail because of a belief/value that was not resourceful. Where the first man had felt like a winner because his needs and priorities were very simple and reasonably attainable, the second man had set his standards so unbelievably high that when he wasn’t able to meet his expectations, he was left to think of himself as a failure. I’m not suggesting that you set goals and expectations so low that you accept the worst. But, you have to admit, our patient’s belief that she would rather die if she couldn’t feel 16 years old again was a sure way for her to sabotage her attitude and train her brain to suffer more than was necessary. Every ounce of suffering we feel is related directly to the interpretation of pain signals in our brains. Hence, it is interpretation, based on attitudes and beliefs, that defines the feelings and severity of pain, and determines the degree to which we suffer. For now, the point is that we have the power to influence and shape our brains in the interpretation of anything and everything in our lives. At a later date, we will discuss in more detail how we can customize interpretation by understanding how our brain and nervous systems work to improve how we cope. This section will get a little wordy, but be patient. Read it a couple of times. These are crucial concepts to help you understand your challenge and help you do a better job as your own advocate in communicating with doctors, getting answers and feeling better. Physicians are faced with their own dilemmas of interpretation. Their intellect, the way they think, and subsequently their paradigm and treatment models are shaped by their education. Education is a mix of academia, mentorship and experience. To understand the academics of education, we must define the mind. The mind is defined as “the facility or function of the brain, by which an individual becomes aware of his surroundings and of their distribution in space and time, and by which he experiences feelings, emotions and desires, and is able to attend, to remember, to reason, and to decide.” (1) Another way to define the mind, as we have discussed up to this point, is that our mind is simply the capacity in which the nerves and chemicals in our brains interact, lead to the formation of opinions and interpretations, and put into perspective the data and signals taken in through our senses. Ayurvedic medicine was developed 3000 years ago in India. (2) This system of medicine involves appreciating the whole person, the mind and body, and treating accordingly. We, in the Western world, managed to separate the mind from the body. Historically, the mind was poorly understood and we had nothing more than gross physical tools to help us understand who we are, how we function and what is in our environment. Consequently, explaining anything that seemed intangible became provocative, including thinking, moods, feelings and the mind. Intangible concepts were separated from tangible. The Scientific world claimed everything tangible. The religious world claimed the intangible. This worked well to give religion power over the mind, and science power over the body. Most doctors, to this day, do not want to deal with abstracts of the mind. There was, however, an evolution of curious, astute, and perceptive doctors, who believed that just because something like the mind could not be explained, didn’t mean it wasn’t real. They began to study the mind, believing that their studies were more than just abstract voodoo. Thus, psychiatry was born, though at best, they were considered in those days to be nothing more than second-rate physicians. Keep in mind that at that time in history, we knew nothing yet of neurotransmitters, neuropeptides and the mechanism of the brain. The majority of Western medicine continued on an academic path developing what is known as the pathogenic approach to medicine, health and disease, also known as evidence-based medicine. Science, Western Science in particular, has somewhat of a big ego, and professes to hold evidence defining all that is real and of this world. Evidence is something that can be observed by all and accepted as real. But what about seemingly intangible concepts such as feelings, love, beauty, fear and pain? These aforementioned notions had been dismissed, or should I say exiled, from science, and relegated for the most part to religion and psychiatrists. Obviously, we hold psychiatry and the study of the mind in great esteem today, but it is in the integration of this study into contemporary medical education where we have failed. Western science has insisted that the mind and body are separate entities. Medical education is the culprit. The impediment is that academics of medicine has traditionally focused on physical evidence. This in itself is not a bad thing; this type of medicine/science has brought amazing improvements and revelation to humankind. It has revolutionized the way we live. However, focusing on physical evidence is only a piece of the puzzle. By not accepting the mind and body as one, we have failed to complete the understanding of ourselves and the human condition. We have essentially retarded progress and actually helped to create conditions such as fibromyalgia. All that evidence-based medicine has accomplished to improve our lives has come at a price. The price is that we have been minimized to the lowest common denominator: scientific theory. In turn, we are forced to live a lie; the lie, in essence, is that we are simply physical beings and all will be well. The truth is almost a cliché; we are more than the evidence, “more than the sum of our parts.” I believe that fibromyalgia, AIDS, and cancer, to name a few, have been created by a system or principal that has left half of who and what we are as humans out of the picture. In a way, these diseases can be considered iatrogenic in nature, that is, physician caused. We have refused to teach medical students that the mind and body are one in the same. Once again, fibromyalgia can be considered documentation of this impediment. The past 3000 years of body and mind understanding must unite with the present evidence-based science, if we are to have a future of hope and ascend from suffering. Ultimately, mentors and medical schools are meant to fulfill a mission, the very reason for doctoring to exist; that is, to serve the sick and suffering. Academics and medical schools focus primarily on structural pathology. Hence, there is a conscious and very strong commitment by professors (mentors) to hand down their beliefs and rationales of disease and treatment, namely understanding organic and structural pathology. (2) Ironically enough, the very principal of the Scientific Theory of reproducible, evidence-based practice and principal is delivered by the logic of “applied convention,” or, as Dr. Yunus has suggested, “invented logic.” (2) With passion and commitment, the beliefs of mentors and medical schools have a powerful influence on generation after generation of our doctors. Logic by applied convention has been very convenient to help simplify, clarify, rationalize, and ultimately, prove the validity of medical principles over the past 300 years. Our beliefs, through logic by applied convention, shape the questions that we are willing to ask. It is the questions that we ask that point the direction to future understanding. It is not hard to understand, therefore, how we could end up in a place of detachment; body from mind and mind from body. But the fact that medical education and mentorship has shaped and directed much of who and what we are into the realm of abstract does not mean that the mind-body relationship is not real and does not exist. The point is that medical doctors are traditionally fixated on the evidence of pathology, and look predominately to chemical solutions. Chiropractic doctors are traditionally fixated on functional pathology and look predominately to physical solutions. Patients are often socialized and brainwashed into believing that our doctors know everything, that they have all the right answers, and further, can prove it with evidence. Interestingly enough, all of this is true. They do know all there is to know that can be proven by evidence. But that which they know and can entirely prove is only part of the picture. We must educate and mentor our medical and chiropractic students in a more comprehensive direction to ultimately fulfill our mission of serving the sick and suffering. The experience of doctors who see and work with fibromyalgia patients every day will help turn and set a new course for education and mentorship. Those of us working with fibromyalgia patients every day see a clear relationship between central sensitization, and the body/mind, as discussed above. Symptoms such as headaches, digestive disorders, chronic fatigue, depression, pain, and sleep problems, all add up to part and parcel of fibromyalgia as opposed to being co-existing and coincidental factors. That is not to say that there are no co-existing or coincidental factors involved in fibromyalgia; there certainly are, and this topic will be discussed further. However, those of us in the field, with many contact hours working with patients and fibromyalgia, should encourage our colleagues to do more research and appreciate the necessity for understanding the basis of the mind/body of which we have been speaking, as it relates to the pathophysiological relationship to CSS. Those professionals who are serious about expanding their understanding, please refer to the following two published papers. *Yunus MB: Central Sensitivity Syndromes: a Unified Concept for fibromyalgia and other similar maladies. JIRA of 8: 27-33, 200. *Brady and Schneider: Fibromyalgia Syndrome. JMPT vol 24, number 8, Oct. 2001. Before moving on, let us take a moment to define some vocabulary in an effort to accumulate a little more perspective. This will help to make the rest of this section, as well as the chapter on treatment options, and the chapter on finding the right doctor, a little easier to absorb. The list below enumerates some other terms that relate to central sensitivity, specifically to neurobiology and chronic pain, as well as so-called co-existing factors. 1. Functional Science/Medicine. In “The Language of Fibromyalgia,” we introduced the term "functional medicine" to mean the function of organs and organ systems, but particularly as it relates to the function of the gut; and issues of toxicity. In my clinical experience, the toxic load on a patient’s system should be addressed in almost every case to speed recovery; particularly with fibromyalgia patients. However, as we move forward, we must include the interaction of all organs and organ systems. The brain and central nervous system is considered an organ system; hence, functional science is related to all organs and organ systems, as well as the relationships between systems. The brain and central nervous system is termed the master control system. It communicates by way of nerves, neurotransmitters, hormones, and electrical energy. It is believed that a glitch in this communication system is what causes central sensitivity. This glitch in an of itself, would be considered a functional problem; however, the glitch has an additional consequence of triggering other functional problems, such as headaches, irritable bowel syndrome, chronic fatigue, and fibromyalgia. 2. Serotonin, thyroid hormones, growth hormones, and substance P are examples of chemicals that influence the nerves of your central nervous system to change the way we interpret our environment. A shift in these chemicals can shift our feelings and how we view the world, ourselves, and interpret or experience pain. Most of us are familiar with serotonin. When serotonin is low, our mood is usually low. This, in turn, affects the way we view events in our lives, feelings, and the world around us. We also know, and will discuss at great length shortly, that when serotonin is low, substance P, which is a chemical found everywhere in our body, tends to be high. When substance P. is high, we become more sensitive to pain. This is one example of how our mind and body are one unit. Note: sensitive means more easily triggered and cognitively exaggerated. Whenever chemicals shift or become out of balance (functional problem); we may develop an emotional or physical symptom. It is simply the way our nervous system and chemical systems interact. You may start to see that there is a real hope for conquering fibromyalgia as the understanding of functional science and functional medicine evolves. The understanding of hormonal secretions and how they interact with our nerves is synonymous with the way our mind and body functions as one unit. You will notice that I mentioned “electrical energy” in terms of brain and central nervous system communication. The theme of this chapter is to bring a broader perspective to the challenge that patients, as well as doctors, face in terms of fibromyalgia. While I have emphasized that the mind and body are related to communications via nerves, neuropeptides and hormonal communication, it is electrical energy and“energy medicine,” ultimately, that will explain any abstract remnants of the cause, pain and suffering of fibromyalgia. We will discuss energy medicine further at a later date. For now, becoming more comfortable with the mind and body as one unit and appreciating the contemporary understanding of communication and interpretive mechanisms of our uniqueness as humans must be firmly in place. 3. Systems There are several terms that we should understand: Neurochemistry – How nerves and chemicals relate. Neurobiology – How nerves and living tissues relate. Neurohormonal – How nerves and hormones interact. Psychoneurochemistry – How the mind works and relates to nerves and chemistry. You can imagine that if any one of these systems were to be out of balance or over stimulated, it could easily cause nerves in your brain to become irritated and sensitized, hence the term central sensitization. A fibromyalgia sufferer could have symptoms for three months, three years, or even three decades. Initially, they may have noticed physical pain only. However, some sufferers initially feel only emotional symptoms such as hopelessness, fear, or depression. With our new understanding of how everything is interconnected (physical and chemical), it is clear that depression, fear and hopelessness can cause areas in your brain to become more sensitive, thus leading to physical symptoms of stiffness or pain. The opposite can also be true; if initially a person feels pain or stiffness due to a physical trauma and the discomfort continues for months or years, can you see how this could now sensitize other areas of the brain, leading to chemical and neurological changes, resulting in depression, sleeplessness, upset stomachs, or other functional problems? Can you imagine the same mechanism causing mental confusion or brain fog? You bet! In this way, it truly is “all in your head.” Most of those reading this book who have fibromyalgia, up until now, would never have accepted that it was all in your head. Well, now you know it is; so when you meet someone who does not understand fibromyalgia, you can comfort the poor, confused soul by telling them “it’s all in my head.” However, before you do that, you may want to read this section again and rehearse your explanation. Or you may not even feel like getting into details and making the effort to thoroughly explain your perspective of fibromyalgia, what you feel, and why so few doctors can help you. Consider this – everyone, including your doctor, is at a different maturity level, in terms of their evolving understanding of health, disease, and evolving science of the mindbody. There are even those who believe that the mind and body are completely separate entities (imagine!). Also consider that some people are more interested in you and what you are experiencing than others. Some have more empathy and would like to help you. Taking into consideration your mood and the person you are speaking to, you’ll want to tailor your explanation. Certainly, your explanation to a child would be different than your explanation to a doctor or a significant other. By the time you finish reading this book, you will develop your own words and your own style to explain what you’re feeling, as well as what fibromyalgia is and isn’t. You’ll be able to share what you need as well as what you don’t need from those around you. For now, here are three basic explanations that will get you by. Explanation of fibromyalgia to your doctor Please know that this book is intended to develop understanding and communication skills. Most importantly, our goal is to help you learn to understand yourself, fibromyalgia, how to communicate with your doctor and therapists, and to clarify diagnostic and treatment options available to you. Therefore, my first suggestion, particularly when trying to communicate with a doctor or therapist, is that you finish reading the book. In the meantime, if you are working with a doctor or therapist who is unfamiliar with fibromyalgia, you may be forced to become the “teacher.” It’s been my experience that a doctor who is not already familiar with fibromyalgia is unlikely to have the interest or take the time to come up to speed for your sake. Doctors are busy, set in their ways and under pressure from managed-care. While it may be an uphill battle, give it a try, as long as he or she has an attitude that you feel is healthy for you. Start by explaining, simply and concisely, the major symptoms that you experience. Initially, your doctor will not need a lot of detailed history on every symptom you have had, everything you have tried, or your diagnosis of why you have what you have. For most doctors, an explanation of the nature of the chronic pain you experience, the fatigue, poor sleep, and depression will suffice. Explain to your doctor that you have done your best to make sense of these symptoms that you’re experiencing, and it seems that this “thing” called fibromyalgia might apply to your case. (You may know more about fibromyalgia than the person with whom you’re speaking; however, your best hope for an ally is to remain humble.) Be prepared by bringing a book with you that you might share with him, a book list, or better yet, a copy of one of the published papers listed above under "Experience." Published papers like these carry with them validity, brevity and speak the “Doctor’s language.” Your doctor is much more likely to read them than to labor through a book. You can get a copy of these publications off the internet, or through a medical school or hospital library. Contact the Enfield Pain Clinic office if you need help. Explaining fibromyalgia to an interested adult Try to make this as short and sweet as possible. It might go something like this: “Well, Betty, what I have is mostly a women’s disease, and it’s kind of like a combination of arthritis and muscle pain, along with chronic fatigue. Some days, it’s really bad, and I can hardly get through the day. My head is kind of foggy, and I can’t think straight, like when you have a bad head cold with a fever. It’s interesting, because not all doctors work with this condition, so usually, it’s only specialists that understand. They tell me that the label for it is "fibromyalgia;" basically it means that my nervous system is irritated and my hormones are out of balance – so I guess that’s what causes the pain, fatigue and brain fog.” Explaining fibromyalgia to children Children close to you will most likely only need a simple explanation of what you are feeling. However, some, especially your own children, will need many reminders of what you are feeling and why you may not be like their friend’s mom. The key for all children is to empower them, not shut them out. Let them know that they can help and you would love it if they did. Make sure they know that how you feel is not their fault. A patient I worked with several years back started a monthly dinner meeting to update everyone in the family about her progress. It served as her forum to keep her teenage children in the loop. She would explain how she was feeling, ask for their help in certain areas, and at the same time allow them to express their feelings, concerns, disappointments and needs. Children piece things together in their minds and may interpret what is going on with you differently than you do. You can help them shape their thinking and their minds, and save them from suffering needlessly. An initial explanation might go something like this: “I feel like you do when you have the flu. My muscles hurt and I’m tired all the time. Do you remember last winter when you had the flu, when you had a fever and you hurt all over? That’s how I feel every day. I know that it causes me to be in a bad mood and sometimes I don’t have the energy to do things with you that you’d like me to. I’m sorry for that, and I’m sorry if I seem crabby. I know some days I just won’t be any fun. I don’t think I’ll have it forever, but I know I’ll have it for a long time.” Barbara, a patient whom we treated about five years ago, created a game to play with her five-year old daughter and six-year old son using Sesame Street characters. The game helped to open communication as well as help her children to feel more empowered. Basically, when Barbara noticed that she was having a bad day, she would take Oscar the Grouch and put him on the counter in the kitchen. When the kids saw the grouch on the counter, they knew that mommy needed some help and wasn’t feeling well. The game was that the children would then go to their rooms, find Elmo, and bring him to their mom to cheer her up. It worked like a charm, always cheered her up and gave her a chance to talk to them so they didn’t feel as though she was mad at them. Barbara’s husband David found that the game was quite resourceful as well. He felt it put him on notice if Barbara was having a bad day, because otherwise he might not understand right away how she felt. There were times when Barbara would just be stuck in what she was feeling and going through and forget to play the game. David would notice and he would get either the grouch or Elmo and bring it to Barbara. Barbara would admit that she was having a bad day, and the three of them, that is Barbara, David and Elmo, would have a chat about it, laugh, and sometimes have a good cry. The perspectives, terms and suggestions we have covered in Fibromyalgia 101 are the basics for putting the pain and suffering of fibromyalgia into perspective. It would not be surprising if you felt overwhelmed or confused at this point. Please either reread the sections that confuse you or proceed and be patient. We will cover in more detail all the same topics in later chapters. I would love for you to share with me your personal perspectives, experiences and definitions of fibromyalgia. Everything you know and everything you have tried has brought you to where you are now and how you feel right now. Dr. Langone believes it is his job to figure out what’s been holding you back from feeling better. He is patient, he will listen to you and answer all of your questions in person, or on the phone. To schedule an appointment for a private consult with Dr. Langone, call (860) 745-7600. If you would like to speak to Dr. Langone, you may be more comfortable having a phone consultation some evening or on a weekend. Call (860) 741-7240 to request a phone consult. For more information (in person or by phone), contact us at: 74 Palomba Dr. Enfield, CT 06082 1. Dorlands Medical Dictionary, 25 th edition
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