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Suggest Treatment For Fibromyalgia
Question: My cardiologist recently told me they believe I have autonomic dysfunction/POTS. They wanted me to see a specialized cardiologist. However, I was wondering if I should also see a rheumatologist as well. I was diagnosed with fibromyalgia years ago and several doctors mentioned that I seemed to have some flexible joints (mostly shoulders, hips, legs, not hands/fingers). I have a lot of joint and muscle pain, my neck has always been the worse and I was told I have a long neck which can contribute to the pain. I get a lot of headaches too. So I went to a pain clinic and they did a radiofrequency ablation on my neck and that really helped with the neck pain and reduced some of the headaches. I read that some people with connective tissue disorders can have autonomic problems or POTS. I am wondering if I should see a rheumatologist or if its a waste of time. I was tested for lyme and it was negative.
Brief Answer:
Autoimmune disease
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, Fibromyalgia is usually a diagnosis of exclusion. So I hope all your other tests pertaining to autoimmune disease have been ruled out like ANA, ENA profile, ESR and complements...
You are right in suspecting a link between autoimmune etiology and Autonomic neuropathy( POTS)...Some conditions like SLE, Sjogrens syndrome are known causes of autonomic neuropathy. I would like to ask you a few queries to see if there is a link and should we investigate you further:
1. Any history of oral ulcers??
2. ANy history of joint swellings??
3. ANy time you experienced rashes over the body or the face...??Which gets worse on sun exposure?
4. Dry eyes or dry mouth?
5. Any swollen glands anywhere?
6. Any history of excessive hair fall??
7. Can you check if ANA and ENA has been done previously...
Do let me know these queries and would guide you further from here
REgards
Dr Naval
Autoimmune disease
Detailed Answer:
Good evening
Thank you for writing on health care magic
Well, Fibromyalgia is usually a diagnosis of exclusion. So I hope all your other tests pertaining to autoimmune disease have been ruled out like ANA, ENA profile, ESR and complements...
You are right in suspecting a link between autoimmune etiology and Autonomic neuropathy( POTS)...Some conditions like SLE, Sjogrens syndrome are known causes of autonomic neuropathy. I would like to ask you a few queries to see if there is a link and should we investigate you further:
1. Any history of oral ulcers??
2. ANy history of joint swellings??
3. ANy time you experienced rashes over the body or the face...??Which gets worse on sun exposure?
4. Dry eyes or dry mouth?
5. Any swollen glands anywhere?
6. Any history of excessive hair fall??
7. Can you check if ANA and ENA has been done previously...
Do let me know these queries and would guide you further from here
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1. I had oral ulcers a lot as a kid but only once in a while now.
2. No significant joint swelling, really painful though.
3. No rashes.
4. Yes dry eyes and dry mouth.
5. I have a small swollen gland in my right arm pit , but it is only visible when I lift my arm, it is not painful and has been there for 2 years without much change in size. Maybe a lipoma?
6. No facial hair.
7. ANA years ago and it was fine. No ENA. ESR and Sed rate were normal
I had some kind of thyroid antibodies, but my TSH and T3/T4 were normal when checked last.
2. No significant joint swelling, really painful though.
3. No rashes.
4. Yes dry eyes and dry mouth.
5. I have a small swollen gland in my right arm pit , but it is only visible when I lift my arm, it is not painful and has been there for 2 years without much change in size. Maybe a lipoma?
6. No facial hair.
7. ANA years ago and it was fine. No ENA. ESR and Sed rate were normal
I had some kind of thyroid antibodies, but my TSH and T3/T4 were normal when checked last.
Brief Answer:
Further course
Detailed Answer:
good evening
Sorry for the late reply... had a long emergency duty
Well, as of now your features don't match the autoimmune disease except the dry eyes and dry mouth. they can be a bit non specific and come with any medicine or autoimmune cause.
As of now I don't think you need a rheumatologist visit. You can ask your gp to repeat the ANA and ENA once as at times these antibodies evolve with time. if negative we can save your visit to the rheumatologist and start treatment for POTS straight away
Hope the information was useful
Do let me know for more queries
regards
dr naval
Further course
Detailed Answer:
good evening
Sorry for the late reply... had a long emergency duty
Well, as of now your features don't match the autoimmune disease except the dry eyes and dry mouth. they can be a bit non specific and come with any medicine or autoimmune cause.
As of now I don't think you need a rheumatologist visit. You can ask your gp to repeat the ANA and ENA once as at times these antibodies evolve with time. if negative we can save your visit to the rheumatologist and start treatment for POTS straight away
Hope the information was useful
Do let me know for more queries
regards
dr naval
Above answer was peer-reviewed by :
Dr. Prasad
Ok. That makes sense. But what about all the joint and muscle pain. It's quite painful and effects my life . I try to stay active. Use ice. Get massages and acupuncture. I take aspirin but it doesn't help much and Motrin really hurts my stomach. Who would be the best to follow up about that? I thought that rheumatologists dealt with that.
Brief Answer:
Fibromyalgia management
Detailed Answer:
Good evening
Well, yes Fibromyalgia is looked after by the rheumatologist itself. I was mainly linking your POTS to any autoimmune cause..
Fibromyalgia normally doesnt cause or is linked to autonomic nervous system involvement. Your pains are probably getting worse due to Fibromyalgia and I can understand, if the another disease taken a bit of toll on your daily life these pains can get worse.
But Aspirin and Motrin are not the treatment of choice for fibromyalgia. If you had ask me the first line, I would prefer amitryptilline or duloxetine as we need a pain modulator than a pain killer in your case. For pain, I would suggest take Tylenol only as it will not harm your stomach or kidneys.
So for getting treatment modified for Fibromyalgia, you do need a visit to the rheumatologist. Kindly refrain from overuse of motrin or aspirin till then
Do let me know for more queries
REgards
Dr Naval
Fibromyalgia management
Detailed Answer:
Good evening
Well, yes Fibromyalgia is looked after by the rheumatologist itself. I was mainly linking your POTS to any autoimmune cause..
Fibromyalgia normally doesnt cause or is linked to autonomic nervous system involvement. Your pains are probably getting worse due to Fibromyalgia and I can understand, if the another disease taken a bit of toll on your daily life these pains can get worse.
But Aspirin and Motrin are not the treatment of choice for fibromyalgia. If you had ask me the first line, I would prefer amitryptilline or duloxetine as we need a pain modulator than a pain killer in your case. For pain, I would suggest take Tylenol only as it will not harm your stomach or kidneys.
So for getting treatment modified for Fibromyalgia, you do need a visit to the rheumatologist. Kindly refrain from overuse of motrin or aspirin till then
Do let me know for more queries
REgards
Dr Naval
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Well I will follow up on that. Could it be possible that Cardizem is making my pain worse? I've been taking it for several weeks and it seems like my joint pain keeps getting worse. Perhaps it just a coincidence but I thought I'd ask
Brief Answer:
Drug side effect
Detailed Answer:
good evening
Well as of the drugs cardizem is not known to cause muscle aches or joint pains. All of the drugs can have a bit of side effect, but it is always difficult to point out if it is the culprit. But yes never seen joint pains as it s common side effect
moreover you have Fibromyalgia as background and not been treated with the right regime. I So I would suggest we try treating it first and see if things get better
Do let me know for more queries
regards
Dr naval
Drug side effect
Detailed Answer:
good evening
Well as of the drugs cardizem is not known to cause muscle aches or joint pains. All of the drugs can have a bit of side effect, but it is always difficult to point out if it is the culprit. But yes never seen joint pains as it s common side effect
moreover you have Fibromyalgia as background and not been treated with the right regime. I So I would suggest we try treating it first and see if things get better
Do let me know for more queries
regards
Dr naval
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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