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| Fibromyalgia - The Misapprehended Pain |
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What Is Fibromyalgia? Fibromyalgia (FM) is a common illness that affects 2 to 4 % of the general population, of which the majority are female. The illness may be triggered by physical or emotional trauma. FM is characterized by chronic widespread pain, by sleeping problems, and by profound fatigue that does not improve after resting. There is significant overlap between FM and CFS. Patients with FM frequently have other symptoms such as:
Another characteristic of FM is tenderness at palpation in defined points at the neck and lower back areas. Is Fibromyalgia Easy to Recognize? The answer is no, for several reasons:
There have been substantial advances in the understanding of the mechanisms that lead to FM. Using a cybernetic technique called heart rate variability analysis, our team has focused on disregulation of the autonomic (sympathetic) nervous system as the cause of FM.
The autonomic nervous system works below the level of consciousness to maintain the body's equilibrium. It regulates blood pressure, pulse and breathing rates among many other variables. It assures the normal function of all of our internal organs. The autonomic nervous system also responds instantaneously to any type of stress. (stress should be understood as any physical or emotional stimuli that threatens the balance of our body). There are close connections between the autonomic nervous system and the endocrine system that regulates hormone secretion. In clinical practice, the function of the autonomic nervous system was difficult to assess up to the introduction in recent years of heart rate variability analysis.
Heart rate variability analysis is based on the fact that the heart rate is not constant, but varies continuously by a few milliseconds. The periodic components of this heart rate variation are dictated by the input of the two branches of the autonomic nervous system: the sympathetic nervous system and the parasympathetic nervous systems. These two branches have antagonistic effects on most bodily functions. Time and frequency domain analyses are able to estimate the relative effect of each branch on the periodic variations of the heart rate. The elegance of this new method resides in the fact that all measurements are derived from electrocardiograms, so patients are not subjected to any discomfort.
We studied a group of patients with fibromyalgia and compared them with healthy controls. By means of portable recorders, we registered the subjects' heartbeat for 24 hours while they followed their routine daily activities. We found that patients with fibromyalgia have relentless hyperactivity of the sympathetic nervous system. This abnormality was also evident during sleeping hours. In a different study, we subjected patients with fibromyalgia to a simple stress test (to stand up). We observed a paradoxical derangement of the sympathetic nervous system response to the upright posture. Such findings have been confirmed by other groups of investigators. The results of these studies suggest that a fundamental alteration of fibromyalgia is a disordered function of the autonomic nervous system. Patients with fibromyalgia lose the normal day/night cycles (circadian rhythms) and have a relentless sympathetic hyperactivity throughout 24 hours. This may explain the sleeping problems that the patients have. At the same time, such individuals have sympathetic hypo-reactivity to stress, which could explain the profound fatigue, morning stiffness and other complaints associated to low blood pressure. This autonomic nervous system dysfunction could induce other symptoms of fibromyalgia such as irritable bowel, urinary discomfort, limb numbness, anxiety and dryness of the eyes and mouth. Fibromyalgia's defining features (chronic widespread pain and tenderness to palpation) could be explained by the mechanism known as "sympathetically maintained pain". After a triggering event (physical/emotional trauma, infections) relentless sympathetic hyperactivity may develop in susceptible individuals. This hyperactivity induces excessive norepinephrine (also known as noradrenaline) secretion, that could in turn sensitize central and peripheral pain receptors and thus induce widespread pain and widespread tenderness. Exquisite tenderness at palpation (its medical term is allodynia) is a typical sympathetically maintained pain feature. This mechanism of pain is supported by our finding that norepinephrine (noradrenaline) injections induce pain in fibromyalgia patients. Fibromyalgia has neuropathic pain features since it is a stimulus-independent pain state accompanied by hypersensitivity to palpation (its medical term is allodynia), and abnormal sensations such as tingling, burning, or electric-shocks. There are important similarities between fibromyalgia and the localized painful syndrome named reflex sympathetic dystrophy. As matter of fact we propose that fibromyalgia is a generalized form of reflex sympathetic dystrophy.
The realization of autonomic nervous system dysfunction in fibromyalgia demands a scientifically holistic approach for its treatment. A correct diagnosis is very helpful to the patient; many patients are relieved to at last find a coherent explanation for all of their complaints. This in turn avoids the costly and constant battery of laboratory tests that many individuals undergo. It is clear that fibromyalgia patients greatly differ from each other, therefore treatment should be individualized and always be supervised by a health care provider. Useful methods that improve autonomic nervous balance are graded aerobic exercises and mind-body relaxation techniques. Liberal intake of mineral water may help symptoms associated to low blood pressure (fatigue, dizziness, faintness). Avoidance of substances with adrenaline-like effects (nicotine, caffeine containing soft drinks and coffee) is recommended. For this chronic illness with multiple manifestations it is important to refrain from excessive use of medications. Patients should understand that there is no “magic pill” that will cure all their symptoms. Medications should be directed to improve sleep and autonomic balance. The main fibromyalgia symptom, widespread pain should be ease with centrally acting analgesics. Anti-inflammatory drugs have little beneficial effect. It is prudent to reiterate that responses to treatment vary and that specific prescriptions through internet are clearly unethical.
The proposal that fibromyalgia is a sympathetically maintained neuropathic pain opens new
perspectives for its treatment. Diverse anti-neuropathic compounds are in the development
period. The intense research that is taking place in different parts of the world will
very likely yield more effective treatments in the near future.
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| American Veterans Day |
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Veterans Day is also celebrated as Armistice Day or Remembrance Day in other parts of the world, falling on November 11, the anniversary of the signing of the Armistice that ended World War I. (Major hostilities of World War I were formally ended at the 11th hour of the 11th day of the 11th month of 1918 with the German signing of the Armistice.) U.S. President Woodrow Wilson was the first President to proclaim Armistice Day for November 11, 1919. The United States Congress passed a concurrent resolution seven years later on June 4, 1926, requesting the President issue another proclamation to observe November 11 with appropriate ceremonies. An Act approved May 13, 1938, made the 11th of November in each year a legal holiday. "a day to be dedicated to the cause of world peace and to be thereafter celebrated and known as 'Armistice Day'." In 1953, Al King, a Kansas shoe store owner actively involved with the American War Dads during World War II, had the idea to celebrate all veterans. So he began his campaign to turn Armistice Day into "All" Veterans Day. King had promoted his notion so much that the Emporia Kansas Chamber of Commerce decided to get involved. With the help of then U.S. Rep. Ed Rees, also from Emporia, a bill for the holiday was pushed through Congress. President Dwight Eisenhower signed it into law on May 26, 1954. Congress amended this act on November 8, 1954, by replacing "Armistice" with Veterans and it has been known as Veterans Day ever since.
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| In-Depth Look at FM Medications - Gabapentin |
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New research supported by the National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) shows that the anticonvulsant medication gabapentin, which is used for certain types of seizures, can be an effective treatment for the pain and other symptoms associated with the common, often hard-to-treat chronic pain disorder, Fibromyalgia (FM). In the NIAMS-sponsored, randomized, double-blind clinical trial of 150 women (90 percent) and men with the condition, Lesley M. Arnold, M.D., director of the Women's Health Research Program at the University of Cincinnati College of Medicine, and her colleagues found that those taking gabapentin at dosages of 1,200 to 2,400 mg daily for 12 weeks displayed significantly less pain than those taking placebo. Patients taking gabapentin also reported significantly better sleep and less fatigue. For the majority of participants, the drug was well tolerated. The most common side effects included dizziness and sedation, which were mild to moderate in severity in most cases.
If you are taking gabapentin for seizures, do not stop taking gabapentin even if you feel better. It is important to continue taking the medication to prevent seizures from recurring. Carry or wear a medical identification tag to let others know that you are taking this medicine in the case of an emergency. Use caution when driving, operating machinery, or performing other hazardous activities. Gabapentin may cause dizziness or drowsiness. If you experience dizziness or drowsiness, avoid these activities.
Take gabapentin exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you. Take each dose of gabapentin with a full glass of water. Gabapentin can be taken with or without food. To ensure you get the correct dose, measure the gabapentin oral solution with a dose-measuring cup or spoon, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one. Carry or wear a medical identification tag to let others know that you are taking this medicine in the case of an emergency. Do not stop taking gabapentin without talking to your doctor. Suddenly stopping gabapentin may cause side effects. If you are taking gabapentin for seizures, do not stop taking gabapentin even if you feel better. It is important to continue taking the medication to prevent seizures from recurring. Store gabapentin tablets and capsules at room temperature away from moisture and heat. Store the gabapentin oral solution in the refrigerator.
Before taking this medication, tell your doctor if you have any other medical conditions, especially:
Also discuss any medicines that you take, including over-the-counter preparations. Gabapentin is in the FDA pregnancy category C. This means that it is not known whether gabapentin will be harmful to an unborn baby. Do not take gabapentin without first talking to your doctor if you are pregnant or could become pregnant during treatment. Gabapentin passes into breast milk. Do not take gabapentin without first talking to your doctor if you are breast-feeding a baby.
Take the missed dose as soon as you remember. However, if several hours have passed and it is almost time for the next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose of the medication to catch up.
Get emergency medical help if you have any of these signs of an allergic reaction:
Other, less serious side effects may be more likely to occur. Continue to take gabapentin and talk to your doctor if you experience:
If children 3 to 12 years of age experience any of the following serious side effects, contact your doctor immediately:
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.
Gabapentin does not interact with other commonly used antiseizure medications. Antacids will decrease the amount of gabapentin that is absorbed in the stomach. Do not take gabapentin for at least 2 hours after a dose of antacid. Gabapentin may increase the effects of other drugs that cause drowsiness, including:
Drugs other than those listed here may also interact with gabapentin or affect your condition. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines, including herbal products.
I hope this article has been helpful. Next month our focus will be on Mirapex.
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| Fibromyalgia & CFS/ME: Help Managing Symptoms |
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During those times, little things can make a big difference. Keeping certain little things close at hand can help you manage your Fibromyalgia (FM) and CFS/ME symptoms and improve your quality of life. The following is a list of simple things that help me get through the day (or night) that don't require a prescription and won't drain your bank account. Capsaicin A long-time arthritis pain reliever, capsaicin rids your cells of a pain messenger called substance P. That's kind of like taking away a computer's Internet connection - no messages get sent. I prefer the bottle that looks like a Bingo dauber so I don't have to touch the medicine. ( Learn more about capsaicin before using it.) Muscle Creams While muscle creams (like Tiger Balm and Aspercreme) don't do much against FM pain, they can provide relief from muscles aches that can contribute to your overall pain level and make it hard to get comfortable or fall asleep. Massage Tools Gently getting kinks out of your muscles can really help you feel better! I sometimes use vibrating massagers, but watch out for those! I have days when my skin almost seems to crawl and my nerves are really jumpy. On those days, the vibration does far more harm than good. Rice Bag A rice bag is uncooked rice inside a little pillow, usually made of flannel or some fabric that feels nice against your skin. You heat it in the microwave for a couple minutes and it releases a soothing, slightly moist heat. It's a great alternative to a heating pad because it gradually cools off and won't start a fire, so you can use it to help you sleep. (Mine also has a flannel pillow case so I have more control over how much heat is against my skin.) Warm, Super Soft Socks or Slippers Why is it that our feet are always cold? I can't answer that, but I know they are! I try to keep something close by for when the chill is on. Cooling Products My temperature is all over the place, and some days I get too hot and just can't cool down. I've used a cooling "scarf" that you just put in cold water for awhile and then wrap around your neck. It feels heavenly and will eventually cool your whole body. I also keep ice packs in the freezer, either for cooling off or for muscle inflammation. Dark Chocolate It may sound strange, but dark chocolate is proven to boost your serotonin levels, which means it can make you feel more awake and give you a mood lift. To get the full effect, get the really dark stuff - like 85% cocoa. Lotion Dry, itchy skin aggravates my FM, and every time I scratch it can cause a lot of pain in the area. If the lotion has a soothing scent, it can do double duty by helping you relax. (Be careful about scented products, however - a lot of us are sensitive to them.) I like the Gold Bond products because they don't "smell" and they work great. Blankets, Pillows and Bedding The more sedentary you are, the more important it is to have a comfortable place that's ready for you at a moment's notice. Even in the summer, I have a luxuriously soft blanket handy in my family room as well as a variety of cozy-feeling pillows. Also, coarse sheets are like sleeping on sandpaper! I prefer flannel or jersey, or a high thread count. Feel before you buy!
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| Fibromyalgia: Diagnosis and Treatment Options |
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Fibromyalgia (FM) is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms. Controlled clinical trials for both medication and nonmedication therapies have led to sound, evidence-based recommendations for the care of patients with FM.
This review article was designed to provide updated information from database literature searches on FM epidemiology, including gender differences, psychological comorbidity, and treatment with medication and nonmedication therapies.
A literature review was performed by identifying FM articles published in English from January 2000 to October 2008 using the PubMed and EMBASE databases. Search terms included FM, exercise, gender, nonpharmacologic, placebo-controlled, randomized, and treatment.
New epidemiologic data support important differences in FM symptom severity between the sexes and the important role of comorbid psychological distress. Physicians diagnose FM in women at an ~3- to 6-fold rate compared with men. Well-conducted clinical trials and recently published treatment guidelines reinforce effective treatment with medication and nonpharmacologic therapy. The strongest evidence suggests effective treatment of FM with duloxetine and milnacipran. Studies also report efficacy with gabapentin, pramipexole, pregabalin, tramadol, and IV tropisetron. Nonpharmacologic treatments should include fitness and strengthening exercise, as well as warm-water therapy and psychological pain management techniques.
FM is a common, disabling, chronic pain condition that predominantly affects women. Symptoms can be effectively treated using both drug and nondrug therapies. In general, treatment benefits in FM appear largely independent of patient sex.
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| Study Ties Mini-Strokes to Memory Loss |
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Their finding comes from a study involving 679 people, aged 65 and older, who were tested for mild cognitive impairment, the stage between normal brain aging and dementia. The researchers used brain scans to check for white matter hyperintensities, which are small areas of damage caused by mini-stroke, and for areas of dead brain tissue caused by stroke. People with mini-stroke damage were nearly twice as likely to have mild cognitive impairment that included memory loss, whereas those with stroke damage were more likely to have mild cognitive impairment that did not include memory loss, according to the report in the Aug. 11 issue of Neurology. "The most interesting finding in this study was that white matter hyperintensities, or mini-strokes, predicted memory problems, while strokes predicted non-memory problems," study author Dr. Jose Luchsinger, of Columbia University Medical Center in New York City, said in a news release from the American Academy of Neurology. "Traditionally, mini-strokes and strokes are thought to have a common origin and to more strongly predict non-memory cognitive problems," Luchsinger said. "There are an increasing number of studies challenging the idea that all white matter hyperintensities are similar to strokes." The finding, he said, "could challenge traditional views that white matter hyperintensities are milder versions of stroke that are produced only by conditions such as high blood pressure." Learning more about mini-strokes and being able to identify which are related to stroke and which are related to other conditions, such as Alzheimer's disease, could help find ways to prevent memory loss and other types of cognitive impairment, Luchsinger said.
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| American Thanksgiving Day |
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In 1621, after a hard and devastating first year in the New World the Pilgrims had beaten the odds. They had built homes in the wilderness, they had raised enough crops to keep them alive during the long coming winter, and they were at peace with their Indian neighbors. Their Governor, William Bradford, proclaimed a day of thanksgiving that was to be shared by all the colonists and the neighboring Native American Indians. The Thanksgiving feast consisted of corn, fruits, vegetables, along with fish which was packed in salt, and meat that was smoke cured over fires. The custom of an annually celebrated thanksgiving, held after the harvest, continued through the years. During the American Revolution (late 1770's) a day of national thanksgiving was suggested by the Continental Congress. In 1817 New York State adopted Thanksgiving Day as an annual custom. By the middle of the 19th century many other states also celebrated a Thanksgiving Day. In 1863 President Abraham Lincoln appointed a national day of thanksgiving. Since then each president has issued a Thanksgiving Day proclamation, usually designating the fourth Thursday of each November as the holiday.
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| Physical Activity and Body Functions in Patients with Fibromyalgia |
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Nowadays, physical activity and exercise, designed to improve or maintain physical fitness, is regarded as an important part of the treatment for patients with fibromyalgia [FM] and other chronic pain disorders. This article reviews the contents and results of programs designed to improve the physical activity of patients with FM, the association between body functions and activity limitations in FM, how physically active patients with FM are, and the role of exercise in the treatment of patients with FM.
Most patients with FM are able to manage low-to-moderate-intensity exercise, while high-intensity exercise should be undertaken with care. Studies examining the effects of exercise have shown that exercise is beneficial for patients with FM. Low-intensity aerobic exercise appears to improve symptoms and overall functioning, while aerobic exercise at moderate to high intensity also improves aerobic capacity. Strength exercise at adequate loads has been shown to result in an increase in muscle strength. Exercise also appears to improve mood.
Physical activity and exercise should be an integrated part of the treatment for patients with FM, as it enhances body functions, activity, and well-being. To enhance adherence, the exercise prescriptions should be individualized to match patients' body functions, activity limitations, and preferences.
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| St. Andrew's Day |
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The story goes that Andrew – the Galilean fisherman who was singled out to be Christ's first disciple – preached the Gospel in the lands around the Black Sea and in Greece and was eventually crucified on an X-shaped cross in Patras. The geography of his mission explains the balalaika, for Andrew is indeed the patron saint of Russia and of Greece as well as of Scotland. The association with a land he never set foot on is, not surprisingly, based on a number of conflicting legends, the most colourful of which is the story of St Rule. Three hundred years after Andrew's martyrdom the Roman Emperor Constantine, himself a Christian, ordered that the saint's bones should be moved from Patras to his new capital city of Constantinople. Before the order was carried out a monk called St Rule (or St Regulus) had a dream in which an angel told him to take what bones of Andrew's he could to 'the ends of the earth' for safe-keeping. St Rule duly took what he could – presumably in a swift and frantic raid on the tomb – and after an epic journey with the aforementioned assortment was shipwrecked on the east coast of Scotland. He must have deemed that he had indeed reached the 'ends of the earth'! Over a millennium later St Rule's Tower still stands among the ruins of St Andrew's Cathedral, which – in its heyday – was a great centre of Medieval pilgrimage. But the whereabouts of the relics is unknown. They were probably destroyed in the Scottish Reformation. During his visit in 1969, Pope Paul VI gave further relics of St Andrew to Scotland with the words "St Peter gives you his brother" and these are now displayed in a reliquary in St Mary's Catholic Cathedral in Edinburgh. But what these comprise – a distal phalange maybe, and the odd canonical fibula – is not recorded.
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| Aerobic Capacity and Self-Reported Fatigue in Patients with RA, PM, and CFS |
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To determine if self-reported levels of physical activity and fatigue are related to peak oxygen uptake (VO2peak) and whether these relationships differ among the patient groups (rheumatoid arthritis [RA], polymyositis [PM], and chronic fatigue syndrome [CFS]).
Two ambulatory research clinics at the National Institutes of Health, Clinical Center, Bethesda, MD. Participants There were 9 patients with PM, 10 with RA, and 10 with CFS. All patients met case criteria for their respective diagnoses. Methods/Main Outcome Measurements VO2peak during bicycle ergometry and self-reported fatigability, fatigue, and physical activity. VO2peak was used as the criterion measurement of physiological fatigue with which the self-reported variables were compared. Results The Pearson r revealed that self-reported physical activity correlated with VO2peak (r = 61, P = .01). However, fatigability and fatigue did not correlate with VO2peak. Linear regression analysis was performed to assess the effects of diagnosis group, self-reported activity level or fatigue, and their interaction. A trend in the data showed a distinctive relationship between fatigue/fatigability within the 3 groups. In addition, when controlling for group status, self-reported activity predicted aerobic capacity as measured by VO2peak. Conclusions This study confirms that patients with chronic, but stable RA, PM, or CFS are fatigued and have significantly decreased aerobic capacity. Self-reports of physical activity predicted VO2peak, and may be used as an indicator of activity-based aerobic capacity. Self-reports of fatigue, however, did not correlate with VO2peak and hence are assessing something other than an index of aerobic capacity, and provide additional information about patients' perceptions, which will require further investigation.
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| On The Lighter Side |
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The Manager says, 'Do you have any sales experience?' The kid says 'Yeah. I was a salesman back in Montana.' Well, the boss liked the kid and gave him the job. 'You start tomorrow. I'll come down after we close and see how you did.' His first day on the job was rough, but he got through it. After the store was locked up, the boss came down. 'How many customers bought something from you today?' The kid says, 'One.' The boss says, 'Just one? Our sales people average 20 to 30 customers a day. How much was the sale for?' The kid says, '$101,237.65.' The boss says, '$101,237.65? What the heck did you sell?' The kid says, 'First, I sold him a small fish hook. Then I sold him a medium fishhook. Then I sold him a larger fishhook. Then I sold him a new fishing rod. Then I asked him where he was going fishing, and he said down the coast, so I told him he was going to need a boat, so we went down to the Boat Department and I sold him a twin engine Chris Craft. Then he said he didn't think his Honda Civic would pull it, so I took him down to the Automotive Department and sold him that 4 x 4 Expedition' The boss said 'A guy came in here to buy a fish hook and you sold him a BOAT and a TRUCK?' The kid said 'No, the guy came in here to buy Tampons for his wife, and I said, 'Dude, your weekend's shot, you should go fishing.'
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| Drug Evaluation: Milnacipran |
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Milnacipran hydrochloride is a serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor that was recently approved by the US FDA for the treatment of fibromyalgia (FM). Evidence has accumulated suggesting that, in animal models, milnacipran may exert pain-mitigating influences involving norepinephrine- and serotonin-related processes at supraspinal, spinal and peripheral levels in pain transmission. Milnacipran has demonstrated efficacy for the reduction of pain as well as improvements in global assessments of well-being and functional capacity among treated FM patients. Its role in addressing comorbidities associated with FM, including visceral pain and migraine, has, as yet, to be investigated. Milnacipran may be of special interest for use in patients for whom hepatic dysfunction precludes the use of other agents, for example, duloxetine. It has a negligible influence on cytochrome metabolism, and therefore may be of particular benefit in patients requiring multiple concurrently prescribed medications. Milnacipran may comprise a reasonable option in the armamentarium of treatments available to manage FM.
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| The Americans with Disabilities Act (ADA) |
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What is the Americans with Disabilities Act? The ADA requires employers with 15 or more employees to provide reasonable accommodations for people who meet the criteria of being disabled, as long as doing so does not place an undue hardship on the company. The act provides definitions of disability based more on symptom severity than on specific diagnoses. Who Qualifies as Disabled? Having a chronic illness like FM or CFS/ME doesn't automatically qualify you as disabled. To be considered disabled under the ADA, you must:
The scope of what's considered a "major life activity" was broadened as of January 1, 2009. The ADA provides two lists - one of basic abilities and one of major bodily functions. Basic abilities include, but are not limited to: |
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Major bodily functions include, but are not limited to: |
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The 2009 amendment specifies that these impairments do not need to be readily apparent from looking at or talking with someone. It also covers you when your symptoms are in remission, as long as you'd be considered disabled when symptoms were active. This is especially helpful for those of us with FM and CFS/ME who have flares and remissions. What is Reasonable Accommodation? If you qualify as disabled under the ADA, you have the right to ask for reasonable accommodations from your employer. (Remember that this only applies to companies with more than 15 employees and cannot create undue hardship on the company.) A reasonable accommodation is any change to your job or work environment that gives you equal access to employment. Examples of reasonable accommodation for symptoms of FM or CFS/ME may include: |
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It's up to you, not your employer, to come up with what accommodations would help you do your job better. Talking to Your Employer The ADA doesn't require a formal meeting or a written request when you talk to your employer about reasonable accommodation - all you have to do is have a conversation in which you tell your employer about your condition and discuss what kind of accommodations would help you. It's a good idea to take notes, keep any pertinent emails, and note any dates on which you talk about ADA issues. Once you've talked to your employer about appropriate accommodations, it's up to the company to provide those accommodations, as long as they don't cause an undue hardship.
To get more information about on-the-job accommodations and the ADA, you can contact the Job Accommodation Network (JAN). If you feel you're being discriminated against or denied your rights under the ADA, contact your local Equal Employment Opportunity Commission or call the national number: 1-800-669-4000 (TTD: 1-800-669-6820.)
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| Events! |
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NOVEMBER 2009 2009 American Osteopathic Association Convention and Scientific Seminar
Date: November 1-5, 2009
Location: New Orleans, Louisiana Description: The 114th Annual American Osteopathic Association Convention and Scientific Seminar will bring together osteopathic physicians, osteopathic medical students, and healthcare professionals to advance their understanding of current healthcare issues and determine ways to secure their future profession. Abstract submission will open in March 2009 and the deadline for submission will be April 30, 2009. More Information: Click Here ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 
Scottsdale Speech
Date: November 9, 2009
Location: Scottsdale, Arizona Description: Claudia Marek will be speaking at the Scottsdale Via Linda Senior Center. Claudia Marek is a medical assistant who has tutored, trained, and taught on the job by Dr. St. Amand, M.D. She is also the co-author of What Your Doctor May Not Tell You About Fibromyalgia. More Information: Contact Dr. Ken Muhich, 480-948-4955, Stetson Chiropractic Clinic. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Welfare Benefits AdviceDate: November 11, 2009 Location: Neurosupport Address: Norton Street, Liverpool L3 8LR Time: 1:00 - 5:00 pm Description: Appointment necessary. More Information: Please Phone 0151 298 2999 to arrange an appointment. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Frequency Specific Microcurrent Seminar
Date: November 20-22, 2009
Location: San Francisco, CA Phone: 360-695-7500 or toll-free 877-695-7500 Cost: $695 Core Description: Carolyn McMakin, D.C., M.A., is offering these hands-on seminar on the history, principles, and use of frequency specific microcurrent for the treatment of fibromyalgia, myofascial trigger points, nerve pain, inflammation, peripheral neuropathies, and more. Licensed professionals, clinicians, assistants, and students are invited to attend. Class size is limited and Costs vary depending on presentation. Early registration discount available. Visit the Website for details of each seminar. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Welfare Benefits AdviceDate: November 25, 2009 Location: Neurosupport Address: Norton Street, Liverpool L3 8LR Time: 1:00 - 5:00 pm Description: Appointment necessary. More Information: Please Phone 0151 298 2999 to arrange an appointment. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ DECEMBER 2009 American Academy of Addition Psychiatry 20th Annual Meeting and Symposium
Date: December 3-6, 2009
Location: Los Angeles, California Description: The AAAP 20th Annual Meeting and Symposium provides researchers and healthcare practitioners the latest developments in treating mental health and substance use disorders. More Information: Click Here ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Fibromyalgia Education & Support Network of Arkansas Meeting
Date: December 7, 2009
Time: Begins at 6:30 pm. Location: Maurice Room Location: Hot Springs, Arkansas Description: Special guest will be Dr. Ryan Johnston. Dr. Johnston has recently relocated to Hot Springs from the St. Louis area where he has orchestrated his wife's fibromyalgia health care. He has specialized his care by treating many chronic conditions, and has successfully managed his wife's fibromyalgia associated symptoms through chiropractic. Dr. Johnston is also an Air Force veteran serving in both Iraq, and Afghanistan. Don't miss out on this opportunity to hear from one of Hot Springs newest health care experts. Potluck Dinner: We are doing a potluck on our regular meeting night. Check out the website to signup for what you want to bring.
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| Parting Thoughts |
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Manuel Martinez-Lavin, MD is Chief of the Rheumatology Department at the National
Institute of Cardiology in Mexico City, Mexico. He has spent many years researching and
treating Fibromyalgia. The following is taken from his website:
Veterans Day is an American federal and state holiday that is celebrated on November
11th honoring all military veterans. If Veterans Day occurs on a Sunday then the
following Monday is designated for holiday leave, and if it occurs Saturday then
either Saturday or Friday may be so designated.
In April we did an article on 
We've all been there: In spite of all the medications, supplements, stress-reducing
techniques and lifestyle changes, some of your symptoms still impose themselves on your
life.
Screening for areas of damage from a possible mini-stroke could help predict memory loss
in the elderly, say U.S. researchers.
In the United States, Thanksgiving or "Turkey Day" is an annual one-day legal holiday
to express thanks for what one has. It is celebrated on the fourth Thursday in November.
The period from Thanksgiving Day to New Year's Day is often collectively referred to as
the "holiday season".
November 30th is St Andrew's Day in Scotland. The patronage of the saint whose name means
'manly' also covers fishmongers, gout, singers, sore throats, spinsters, maidens, old
maids and women wishing to become mothers. But just who was Saint Andrew and how did he
become the patron saint of Scotland?
A young guy from Montana moves to Florida and goes to a big "everything-under-one-roof"
department store looking for a job.
It can be a challenge to keep working when you have fibromyalgia (FM) or chronic fatigue
syndrome (CFS/ME). Sometimes, it can help to change certain aspects of your job.
The Americans with Disabilities Act (ADA) is designed to protect your right to employment
by requiring most employees to make changes - called "reasonable accommodation" - to help
keep you working.
