By Ruth Tricker
CR is a 42-year-old gardener who has been treated over many years for gynaecological problems, anxiety depression and irritable bowel syndrome (IBS).
In 1998 she presented with a marked change in her usual symptoms of PMS and depression, and described a history of increasing fatigue and insomnia accompanied by flu-like symptoms.
This had been preceded by a period of more than usual stress and anxiety.
Her main symptoms were generalised aching in the upper thoracic area and arms, neck stiffness, and aching in the lumbar area as though she ‘might be getting the flu’.
These symptoms became worse if she slept poorly or was very stressed, if she worked for long hours or many days without a break, or if she became very cold.
She was unclear as to how long the aches and pains had been present, but thought that they had been gradually becoming more generalised over the past three months. She had not caught any colds or flu for the past year and had no obvious signs that indicated that she had any type of viral infection.
During the last six months she had been seeing a masseur for relief of pain in the arms that she described as a type of over-use syndrome related to her job.
It was quite difficult to obtain a clear history from CR. She was only able to give a vague indication of pain distribution and quality because she was ‘having a good day’ at the time of the consultation.
This is common in chronic pain syndromes; it can be quite difficult to arrive at a diagnosis because pain is often ‘forgotten’ and is notoriously difficult to describe. I was fairly certain that her symptoms were consistent with fibromyalgia, but asked her to keep a pain diary for the next month outlining:
- Pain severity, quality and distribution
- What brought on the pain or exacerbated it once present
- Any limitation of use of the affected area or in activity levels brought about by the pain
- Any stiffness accompanying the pain
- A description of other complaints present at the same time
I planned to use this information in a referral letter to her GP or to a rheumatologist if this was thought necessary.
Prior to her next visit she had been seen by her GP and then a rheumatologist who confirmed a diagnosis if fibromyalgia. She was offered no treatment apart Epilim (which she refused to take) and some vague advice about changing her lifestyle.
I suggested she attend a comprehensive lifestyle program offered for fibromyalgia, but she was very resistant to this idea. As a compromise she agreed to do yoga regularly and she was started on the following herbs and supplements with good effect:
Herbal formulation
Withania somnifera 40 ml Hypericum perforatum 20 ml Lavandula officinalis 20 ml Zizyphus spinosa 20 ml Total 100 ml Dosage: 7 mL BD
Nutritional supplementation
Magnesium Biocomplex 2 BD, Withania is a nervine tonic and adaptogen and seems to be specifically indicated for fibromyalgia.
A postulated mechanism of action is that this herb dampens the fight and flight response via its adaptogenic properties and facilitates improved relaxation.
Improving sleep patterns seems to be an essential component of fibromyalgia treatment.
Lavendula and Zizyphus are indicated for anxiety, have a calming action and improve sleep.
Hypericum seems to moderate pain response as well as improving sleep patterns, particularly when repeated waking is a problem.
Magnesium aids muscle relaxation, reduces pain levels and improves sleep.
CR stayed on the herbs and magnesium for 6 months without a break and then intermittently as needed for the next three years.
In 2002 she reported that the herbs were no longer helpful and that she had developed pain in the hands wrists and feet.
In addition to the Withania mix, she was given Boswellia Compound 2 BD. These symptoms settled within one month and the Boswellia was discontinued. Another of these episodes occurred in 2003, but settled quickly with Boswellia.
Early this year, she again presented with an episode of pronounced pain. Her primary symptoms were painful joints, particularly the PIP, MCP and MTP joints, wrists and occasionally her ankles and knees. She described prolonged stiffness on arising lasting for about one hour.
Examination revealed limitation in range of movement and pain in the left wrist, both ankles and most digits on both hands with slight joint swelling in several PIP and MCP joints.
These symptoms are much more likely to be related to an inflammatory arthritis rather than fibromyalgia. She was sent back to her rheumatologist for an opinion on these developments who felt that she either had sero-negative rheumatoid arthritis or psoriatic arthritis.
X-Rays of hands and feet were ordered which showed minimal joint destruction. She was prescribed Vioxx 25 mg daily although her rheumatologist agreed that pain management was more than adequate with Boswellia and that she should only use the Vioxx as rescue medication (ie when the pain was not controlled by Boswellia)
Her prescription has been changed to:
Herbal formulation
Withania somnifera 40 ml Hypericum perforatum 15 ml Lavandula officinalis 15 ml Curcuma longa 30 ml Total 100 ml Dosage: 7 mL BD
Nutritional supplementation
- Magnesium Biocomplex 2 BD
- Boswellia Compound 2 BD – TDS depending on pain and stiffness levels
- Glucosamine might also be considered for a presentation like this, but has not been offered to CR because she is a strict vegetarian.
- CR is generally more careful about her diet now and has included high levels of dietary omega-3 fatty acids including 3 dessertspoons of flax seed oil. The possible relationship between autoimmune disease and cross-reactivity with a number of gut bacteria means that the IBS symptoms should be treated aggressively.
- She is now compliant with dietary suggestions for this and regularly eats the seed breakfast with slippery elm powder, lactobacillus and whey to correct any leaky gut and improve levels of healthy gut bacteria.
- She has also been on a one-week detoxification diet and the plan is to repeat this every six months.
- Stopping gluten foods as a trial for the past two months has also appeared to help her symptoms.
mexican pharmaceuticals online: mexico pharmacy – best online pharmacies in mexico
best online pharmacy india https://indiaph24.store/# top 10 online pharmacy in india
п»їlegitimate online pharmacies india
https://indiaph24.store/# indian pharmacies safe
http://mexicoph24.life/# mexican pharmacy
п»їbest mexican online pharmacies: mexico pharmacy – mexico drug stores pharmacies
cytotec pills online: buy cytotec online fast delivery – cytotec online
order propecia no prescription buying generic propecia without insurance cost propecia tablets
http://lisinopril.network/# 2 lisinopril
lexapro and tamoxifen: nolvadex for pct – how to get nolvadex
lisinopril 40 mg lisinopril 40 mg prices lisinopril 20 mg tablet cost
http://lisinopril.network/# lisinopril buy online
http://ciprofloxacin.tech/# ciprofloxacin over the counter
Abortion pills online buy cytotec pills Cytotec 200mcg price
zestril 5 mg: 50mg lisinopril – price of lisinopril in india
https://finasteride.store/# cost of propecia pills
ciprofloxacin mail online where can i buy cipro online buy cipro online canada
does tamoxifen cause menopause: buy tamoxifen – low dose tamoxifen
https://finasteride.store/# get propecia without insurance
cost generic propecia online cost of cheap propecia without a prescription buy cheap propecia without insurance
https://nolvadex.life/# is nolvadex legal
lisinopril price in india: generic lisinopril online – lisinopril 40 mg cost
http://cytotec.club/# cytotec buy online usa
cheap propecia prices: propecia tablet – cost of generic propecia without dr prescription
order cytotec online purchase cytotec buy cytotec over the counter
https://nolvadex.life/# tamoxifen cancer
https://ciprofloxacin.tech/# cipro online no prescription in the usa
buy cheap propecia without a prescription: cost cheap propecia without a prescription – cost cheap propecia tablets
cost generic propecia pill propecia otc cost of generic propecia without insurance
http://ciprofloxacin.tech/# ciprofloxacin 500 mg tablet price
nolvadex during cycle tamoxifen cyp2d6 tamoxifen rash
3 lisinopril: lisinopril 2.5 mg cost – lisinopril 10mg tablets
http://ciprofloxacin.tech/# ciprofloxacin mail online
https://ciprofloxacin.tech/# where can i buy cipro online
generic propecia no prescription: get propecia price – cost propecia without dr prescription
https://cytotec.club/# cytotec online
buy generic ciprofloxacin: buy ciprofloxacin – buy cipro
buy cytotec online fast delivery buy cytotec over the counter buy cytotec pills online cheap
http://ciprofloxacin.tech/# п»їcipro generic
cost of generic propecia without dr prescription: cost of cheap propecia without rx – get generic propecia tablets
http://finasteride.store/# buy propecia without dr prescription
cost cheap propecia prices propecia buy order propecia
https://finasteride.store/# buy cheap propecia pill
Sildenafil 100mg price: Cheapest place to buy Viagra – Viagra Tablet price
http://levitrav.store/# Buy Vardenafil online
Kamagra Oral Jelly: super kamagra – Kamagra tablets
http://cenforce.pro/# Cenforce 150 mg online
https://levitrav.store/# Buy Vardenafil 20mg
http://kamagra.win/# buy Kamagra
Generic Tadalafil 20mg price: Cialis 20mg price in USA – Buy Cialis online
http://levitrav.store/# Levitra 10 mg buy online
Levitra online pharmacy: levitrav.store – Vardenafil price
Buy Levitra 20mg online buy Levitra over the counter Generic Levitra 20mg
https://cenforce.pro/# cenforce for sale
super kamagra: sildenafil oral jelly 100mg kamagra – kamagra
http://kamagra.win/# п»їkamagra
http://kamagra.win/# Kamagra 100mg price
http://kamagra.win/# Kamagra 100mg
Levitra online USA fast: levitrav.store – Cheap Levitra online
no prescription pharmacy paypal: online pharmacy – pharmacy discount coupons
http://pharmworld.store/# canadian pharmacy no prescription needed
http://pharmcanada.shop/# canadian pharmacy 24h com safe
top 10 pharmacies in india: buy medicines online in india – online shopping pharmacy india
safe canadian pharmacies best canadian online pharmacy reviews canadian discount pharmacy
https://pharmcanada.shop/# www canadianonlinepharmacy
india pharmacy mail order: indianpharmacy com – Online medicine home delivery
promo code for canadian pharmacy meds: pharm world store – overseas pharmacy no prescription
http://pharmindia.online/# top 10 pharmacies in india
reputable mexican pharmacies online: mexico pharmacy – mexican drugstore online
mexico pharmacy mexico drug stores pharmacies mexico pharmacies prescription drugs
http://pharmindia.online/# top 10 pharmacies in india
online medication without prescription: buy medications without a prescription – canadian prescription
mexico drug stores pharmacies mexican mail order pharmacies mexican border pharmacies shipping to usa