Research suggests a bias in how people with fibromyalgia (FM) recall pain, with intense pain usually exaggerated in recall.

Researchers suggest that psychosocial factors, such as patients’ own assessment of their physical abilities, may affect FM patients’ pain recollection.

The study, “A longitudinal analysis of pain experience and recall in fibromyalgia,” was published in International Journal of Rheumatic Diseases.

Pain in FM is usually measured via self-reports; however, this has been shown to lead to disparate results, likely linked to the fact that how people experience pain is often different than their memory of that painful episode.

Increasing research suggests that memories of painful experiences are “more powerful predictors of future pain than the actual previous pain experiences,” researchers said.

“These findings engender questions of what pain recollections truly reflect, how pain recollection differs by populations, what factors moderate pain recollection accuracy and how they operate similarly across differing populations,” they stated.

Evidence shows that pain recall is affected by psychological, social, and biological factors — depression was shown to negatively affect pain recollection and one study showed that glucocorticoid cortisol, a hormone released during a stress response, also changed how a group of healthy males experienced pain during a controlled experiment.

While research into factors that affect pain recollection has been done in some populations of patients with an identifiable cause for their pain, “no research has been done to assess these processes among those with fibromyalgia.”

Researchers analyzed data from 572 FM patients to understand how they experience and recall memories of pain.

The patients were asked to perform — in five different moments over a period of one year — a self-assessment of their FM-related pain levels at that “present moment” (experiential pain or EP), an assessment of what they considered the level of the highest FM pain they had ever experienced (historical peak pain or HPP), and the level of their lowest FM pain (historical valley pain or HVP).

Recollections of FM pain were compared to recollections of other types of pain, such as the worst toothache pain, or the worst stomach pain, that were recorded at the same timepoints.

The authors found that pain recall in FM patients changes over time, with a tendency for a decrease of all FM pain experiences, which didn’t happen when patients were asked to recall other non-FM pain experiences.
Moreover, momentary pain experiences of those with FM are systematically closer to their lowest levels of pain than they are to their highest levels of pain.

Of note, and in accordance with previous studies, the accuracy in recalling pain levels was lower among depressed FM patients — this set of patients seems to have a tendency to inflate past peak pain levels and momentary pain, but not so with lowest pain levels. “Depression does not relate to inflations of all pain, but only peak recollections and present pain experiences,” the authors wrote.

The authors identified other factors that can contribute to fibromyalgia pain syndrome (FMS) pain recollection, such as self-efficacy (i.e. the assessment the patients do of their own ability to perform physical tasks), or sleep impairments.

In this study, higher self-efficacy seems to lessen pain experiences in FM and to deflate recall of the severity of historical pain, while impaired sleep was correlated with inflation of all FMS pain experiences.

Researchers could also corroborate previous data that suggest age seems to alter the intensity with which individuals remember past negative experiences, in this case peak FM pain.

Over the year that patients were asked to recall their current FM pain compared to past FM pain experiences, all of them said their pain experience levels decreased. This suggests that the act of recollection might help FMS patients cope with their momentary pain levels.

Because current pain levels were always closer to lowest historical pain, it seems that “asking patients to report their average pain on ‘good days’ (pain at its least) might be a good reflection of their typical daily pain experiences,” researchers said.
​
Moreover, these results suggest “that memory related to pain might be a worthwhile target for intervention,” the study concluded. - Shared by Patricia Inacio, PhD

Some of the less defining symptoms of fibromyalgia and often least discussed is the addition of anxiety and panic attacks.  

You are already on a cruise of multiple syndromes where few family members can identity your state of mind and what's causing it. Add to that the consistent withdraw mode during family affairs, and you're already labeled as a bit off and untouchable.  

So to totally immerse in the anxiety/panic disorder ordeal may become a bit too intense to share with loved ones, too.  Some of us prefer to keep that to ourselves and deal with it internally as much as possible so we don't look way-out-there. 

But, why does this happen? Speculation in scientific studies discusses it is possible due to the chronic pain we suffer.  It kind of sets our systems out of wack and makes us more vulnerable to sensory stimulation.

But, I didn't have this heightened anxiety during my first couple of years first diagnosed with Fibromyalgia when pain was more intense.  I can tell you I remember my first incident like it was yesterday when panic disorder first surfaced.  I had been on a family trip and we decided to check out Ruby Falls.  We are avid nature lovers when we are away so this type of excursion was not out of the ordinary.  

Cave tours was always part of the vacation venue.  We've always tried to fit them in when the area allowed. To  get to this cave, you had to take an elevator.  Twenty six stories down.  I've done this before, "I got this," I thought.  It didn't seem to out of the ordinary.

We immediately got into line and perused all the local art on display as we moved along.  Things were going along pretty smoothly until we were about two minutes to entry.  Then a jolt of energy pierced my brain and began stimulating obscure thoughts.  "How far down is this elevator?" "Why don't you have more information on this?"  "How long are you going to be down there?"  "You really haven't taken anytime to overview this before departure." "What are you doing?"

I pushed them aside.

The closer I came the more exclamatory the thoughts became.  They were no longer a whisper, but an all out howl demanding for more intercession before proceeding.

I have never experienced this before.  What was happening?

Still standing tall, I walked into the elevator.  "This is crazy," I thought.  "I am an adventurer, this too shall pass." 

I looked at my son.  He looked at me taking mental notes something is really off.

Then it started.  My heart began to race.  Well, not actually race, rattle would be a better term as it bounced within my chest walls. My throat began to close.  I could not breathe.  Oh, this was real and not passing.

"I have to leave," I told my son and darted off.  They proceeded without me, and I spent two hours sniffling on the side barrier wondering what has become of my life until they returned.  

People with fibromyalgia (FMS) and chronic fatigue syndrome (ME/CFS) often experience anxiety symptoms and panic attacks.

Panic disorder can be debilitating and have a major impact on your life. It can make you afraid of every-day situations like going to work; strain your relationships; and cause you to avoid things that might trigger symptoms. When you add this to FMS and ME/CFS, which are debilitating on their own, the problems can compound each other.

Sometimes, symptoms are mild and don't require treatment -- you just learn to deal with them. I call this avoidance therapy - which has constricted my life a bit. Other times, though, when more severe, they may be an overlapping condition such as panic disorder. If that's the case you with, you'll need proper diagnosis and treatment in order to stop being held captive by anxiety.

​Even if your panic and anxiety symptoms doesn't meet the criteria for a formal diagnosis, certain treatments and coping strategies may be beneficial to you. Therefore, it is important to discuss these symptoms with your doctor and make some lifestyle changes.

​Physical and Emotional Symptoms of Panic Attacks

According to the DSM-5, a panic attack is characterized by four or more of the following symptoms:

1. Palpitations, pounding heart, or accelerated heart rate
2. Sweating
3. Trembling or shaking
4. Sensations of shortness of breath or smothering
5. Feeling of choking
6. Chest pain or discomfort
7. Nausea or abdominal distress
8. Feeling dizzy, unsteady, lightheaded, or faint
9. Feelings of unreality or being detached from oneself
10. Fear of losing control or going crazy
11. Fear of dying
12. Numbness or tingling sensations 
13. Chills or hot flushes

The presence of fewer than four of the above symptoms may be considered a limited-symptom panic attack. In order for a diagnosis of panic disorder to be made, recurring, spontaneous panic attacks must be present.

Treating Panic Disorder

Most of the treatments for panic disorder are also utilized in FMS and ME/CFS, so they may do double duty for you. When deciding on treatments, be sure your doctor is aware of all your diagnoses so he/she can choose the best options for you.

• Antidepressants
• Benozodiazepines
• Choose a Therapist

Also see:

• Cognitive Behavioral Therapy for Fibromyalgia
• Cognitive Behavioral Therapy for ME/CFS

​Self Management

You can do a lot on your own to manage the symptoms of panic disorder. The information and strategies below can guide you toward healthy ways to prevent panic attacks and how to get through them when they strike.

• Living with Panic Disorder
• How to Stop Worrying
• Getting Through a Panic Attack

Panic Disorder and the People in Your Life

Coping with any illness is difficult, and it can be worse when it's mental illness. These articles on relationships and helping other people understand your condition may help you and the people in your life come to terms with your disorder.

• Panic Disorder and Relationships
• Help Family and Friends Understand

Above all, talk to you physician and ensure this doesn't get out of control.  Make sure your symptoms are documented. Most of all remember you are not alone.  

As the sun wanes down, and winter begins to take effect, getting out in the sun makes is all but impossible to gain that helpful nutrient Vitamin D.  One thing that is becoming a constant plague is hip flexor pain.  It seems as the week drones on, pain begins to radiate on both sides of my hips while walking.  I'm sharing an article from Living Smarter with Fibromyalgia to offer some insight:

​It is not uncommon to have hip flexor issues or pain in this area when living with fibromyalgia. The hips, hip flexors, and lower back correlate with fibromyalgia pain areas due to tender areas around the lower back, many more trigger point areas and other conditions that affect the surrounding areas. 

The hip flexor muscles allow your hips to move with flexibility. You are engaging these muscles whenever you move your legs, and that means your hips are involved in most of the movements that you make throughout the average day. 

A healthy person may not realize how often they use their hip flexors, but anyone living with fibromyalgia who experiences hip flexor pain will be well aware of this on a more regular basis. 

I have personally dealt with hip flexor pain and then later re-strengthening of these areas while developing more fibro safe exercises after my full hysterectomy three years ago. Yes, I do get it. I will address more of this later in the lower part of this article.

While there are some known injuries and medical conditions that can cause pain in the hip flexors, it can be difficult to identify a direct cause of this pain in someone with fibromyalgia, except for the many daily activities that I often refer to. 

We might treat the pain as another symptom of the diagnosed condition or take more time to determine an exact cause for the pain. Either way, the fibromyalgia and hip flexor pain is often debilitating if not treated efficiently and promptly.

​Hip flexor pain is often referred to as flexor tendinosis. The pain from this condition typically comes from one or both of the following muscles: Illicacus and Psoas. These muscles are often lumped together as one unit, referred to as the illiopsoas. 

The psoas is responsible for a lot of general back and leg pain because the sitting positions that most people hold throughout the day cause the muscle to shorten for a long period of time. When you stand up and start moving around again, that muscle doesn’t want to lengthen and function properly.
For those suffering from fibromyalgia, the pain may come from other muscles that help the hips move. This includes the quadriceps, even though those muscles are lower than most hip flexor muscles. 

While flexor tendinosis caused by an injury or issue not related to fibromyalgia may focus on one particular muscle or area of the hip, fibromyalgia patients may experience pain that spreads out throughout this region of the body. The cause of the pain is often unexplainable, as is typically the case with fibromyalgia pain.

​One simple way to prevent some fibromyalgia and hip flexor pain is to avoid sitting in one position for a long period of time. Get up and move around periodically so that your muscles don’t have time to set in one position. 
You often hear me recommending safe and effective exercise and the importance of participating in some level of exercise in order to keep your body strong and more flexible, and this is another recommendation for hip flexor pain as well. 

As an alternative to straps and/or bringing the neck forward, bring a chair up to you close while lying on floor, then cross one leg over the other just above the knee, and hold. The chair really acts as a person or therapist helping you to stretch in a safer and more effective way. 

The stretch I am performing here is great to do anytime, especially after sitting. We draw up on one leg (no shoes) to just above OR below the knee, (this loosens the hips) then draw the arm up on the same side and feel the light stretch from your hips through your obliques. Here, I am putting my heel just ABOVE the knee, not on the knee itself. ​
​
Slightly different than yoga, what we do is more range of motion techniques for fibromyalgia. Therefore, avoid pushing into the knee or inside of opposing leg. The idea is to lift and stretch through the movement. 

If you spend much of your day sitting at a desk, invest in an office chair that is highly adjustable. Set the chair higher, allowing your hips to rest above your knees. This position is healthier for your hip flexors and may eliminate pain caused by the shortening of those muscles in the typical office chair position. You may also want to consider a standing desk that allows you to easily lift your work space.

These last couple of months I shared several studies concerning heart failure in patients with fibromyalgia.  I also shared a recent blog post on the importance of having a sleep study done.  After further research, it seems that it is believed that 50% of fibromyalgia patients also suffer from Sleep APNEA.  So, you are already, I'm sure, making the connection that sleeping disorders can also attribute to high blood pressure, heart disease, and heart palpitations.  

It is inconclusive if the sleeping disorder causes the fibromyalgia, or if the fibromyalgia causes disruptions in the breathing canal due to relaxing the the nerves within the muscles too much so that it blocks the airway.

I have been a candidate to use a CPAC due to moderate Sleep APNEA.  If I can get used to using this machine is another blog all together.  But, I can tell you the newer machines are quiet, have comforting flexible tubing, and are completely automatic when aligning your breathing needs to computerized software that gradually increases your air pressure needs without any prompting.    They are, by far, the most up-to-date available and can meet the needs of the most sensitive individual.  Best of all, with most insurances they are free.  On top of all that, most supplies are free, too, and can be interchanged every three months to ensure cleanliness.  

That said, if you haven't spoken to your doctor about a sleep study yet, I leave you with the following article from Fibromyalgia Today:

​Researchers at Istituto Figlie di S. Camillo in Italy recently reported that fibromyalgia is common among patients with obstructive sleep apnea (OSA). The study was published in the European Journal of Internal Medicine and is entitled “Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy”.

Fibromyalgia is a medical disorder characterized by a set of symptoms including widespread chronic musculoskeletal pain, incapacitating fatigue, stiffness and numbness in certain parts of the body, painful response to pressure, headaches, unrefreshing sleep (poor sleep quality), anxiety or depression and mood alterations. Fibromyalgia can affect people’s ability to conduct simple daily tasks, compromising their quality of life. It is estimated that 5 to 15 million Americans are affected by this disorder, especially women where a prevalence of 3.4% has been reported in comparison to 0.5% in men.

The poor sleep quality experienced by fibromyalgia patients has been suggested to be a key factor of disease pathogenesis. The prevalence of OSA (an obstruction of the upper airway characterized by repetitive episodes where the individual stops breathing during sleep) among fibromyalgia patients is not clear. In addition, data is also lacking on the impact of continuous positive airway pressure (CPAP) use, a device that helps individuals with OSA to breathe more easily during sleep.

Now researchers determined the incidence of fibromyalgia in OSA patients and the role played by CPAP as a therapeutic option. In total, 900 OSA patients were assessed in the study through a sleep test with a 25-channel portable polysomnography recording device, an Epworth sleepiness questionnaire, a full medical examination and a detailed analysis of their medical history.

Researchers reported that 15% of all OSA patients (135 individuals, mean age of 40 years) met the American College of Rheumatology (ARA 2010 version) criteria for a fibromyalgia diagnosis, and that of these, 74% were men (100 individuals). This is a curious fact as fibromyalgia is more common among women in the general population. All these patients were then submitted to a 6-min walking test, completed the SF-36 standard questionnaire (health survey form) and assessed in terms of symptoms severity scale and CPAP titration scores. Of these patients, 30 were excluded because they failed the scheduled follow-up, and five refused treatment. The remaining 100 patients were treated with CPAP, with follow-up visits at 3 and 6 months. As controls, 50 patients with fibromyalgia were treated with conventional therapy (tricyclics, serotonin reuptake inhibitors and gabapentanoids).

The team found that treatment with CPAP resulted in an overall superior improvement in the functional symptoms of the disease compared to conventional therapy. Patients under CPAP treatment had a significantly decrease in the apnea hypopnea index (AHI), an improved 6-min walking test result, and a reduction in symptoms severity scale.
​
The research team concluded that fibromyalgia is frequent among OSA patients, and propose CPAP treatment as an effective therapy for these patients.

The use of oral fluoroquinolones (FQs) poses the same level of fibromyalgia risk as other antibiotics such as amoxicillin and azithromycin, a study suggests.

The study, “Oral Fluoroquinolones and Risk of Fibromyalgia,” was published in the British Journal of Clinical Pharmacology.

Oral FQs, which are the most prescribed antibiotic, received a black box warning in 2016 from the U.S. Food and Drug Administration. The warning was based on severe side effects reported after the use of FQs that resembled fibromyalgia — widespread amplified pain in the muscles and joints. But the prevalence of this risk has not been quantified in detail.

Of significance, respiratory infections, for which FQs might be prescribed, may also lead to fibromyalgia, which could confuse the association between fibromyalgia and FQs.

In this study, researchers in Canada aimed to correlate the use of FQs to cases of fibromyalgia that were part of health claims filed between 2006 and 2016.

Using a large health claims database in the U.S., PharMetrics Plus, the team identified cases reported as fibromyalgia by a rheumatologist. All FQ prescriptions were identified, and only those individuals whose FQ prescription preceded their fibromyalgia diagnosis entry by three months to a year were included. Patients who were prescribed amoxicillin and azithromycin were also included.

Amoxicillin and azithromycin, which are chemically different from FQs, served as a control for any effects seen because of a bacterial or viral infection mimicking fibromyalgia.

The team identified 5,148 such cases and included 51,480 cases without a fibromyalgia diagnosis as controls. Of the 5,148 fibromyalgia cases with past FQ, amoxicillin, or azithromycin use, 87% were women.

Of these three antibiotics, the researchers found that the chances of a fibromyalgia diagnosis being associated with FQs was 1.63 times higher, amoxicillin 1.64 times higher, and azithromycin 1.68 times higher than in the control group. No significant difference was noted between the three antibiotic groups.

These results indicate that the risk of fibromyalgia with FQs is similar to that of amoxicillin and azithromycin, according to the authors.
​
“Despite the case reports of fibromyalgia and FQ use in both the literature and various drug regulatory agencies, risk seems to be similar with amoxicillin and azithromycin,” they wrote. “Risk might therefore be due to possible infection that triggered fibromyalgia symptoms.” - Shared from Fibromyalgia News Today

My cardiologist also ordered a sleep study test due to the recent heart complications.  As I took my referral home, a thought plagued my mind.  Why had my neurologist never ordered this test?  

When I was first diagnosed with fibromyalgia, I spent many a night up.  Each time I'd try to fall asleep, electrical charges pulsed my body continuously.  This situation never died down completely.  I just notice it happens less frequently.  

​Obstructive sleep apnea (OSA) affects more than 18 million Americans. Left untreated, sleep apnea can have serious and life-shortening consequences: high blood pressure, heart disease, stroke, automobile accidents caused by falling asleep at the wheel, diabetes or depression. An in-home or in-center sleep study can diagnose OSA and many other sleep disorders.

It could be one of these risk factors:

• You’ve complained of excessive daytime sleepiness
• Your neck circumference is over 17″ (for men) or 15″ (for women)
• You’ve complained of waking up with morning headaches, dry mouth or a sore throat
• Your bed partner has observed that you gasp for air in the night
• You wake up frequently in the night to urinate
• Your body mass index (BMI) is over 30

​
In preparation for your in-lab sleep study, it's important to know some of the key differences between the different types of sleep studies offered at sleep clinics.
​

1. Polysomnogram (PSG). A polysomnogram is an overnight sleep study that records brain activity, eye movements, heart rate, blood pressure, oxygen levels, body movement, and more. Polysomnograms are used to help diagnose some of the following:
   • Sleep related breathing disorders such as obstructive sleep apnea (OSA).
   • Sleep related seizure disorders.
   • Sleep related movement disorders such as periodic limb movement disorder (PLMD).
   • Sleep related disorders caused by excessive daytime sleepiness (EDS).
2. Multiple Sleep Latency Test (MSLT). A MSLT is a sleep study that is performed during the day to measure how sleepy you get or to discern whether breathing treatments for your disorder are working properly. MSLT's generally follow a Polysomnogram and record whether you fall asleep during the test, and if so, which stages of sleep you enter. In an MSLT you are generally given five 20-minute nap opportunities spaced 2 hours apart while a sleep technician monitors your brain activity and eye movements. An MSLT is often used to test for narcolepsy.
3. Maintenance of Wakefulness Test (MWT). A MWT is a daytime sleep study that measures how alert you are during the day and your ability to stay awake. They are usually performed after a PSG and can help determine if your sleepiness is a safety concern. Results of an MWT can be critical if a person's job involves public transportation. Often, employers will require an employee to have an MWT if they have a history of excessive daytime sleepiness or other related sleep disorders.

How To Prepare for Your Sleep Study

Most sleep clinics want you to go about your nightly routine so as to get the best results. If you over-prepare or do things differently leading up to your sleep study, the results may not be as accurate as they would if you kept to your normal routine. It sounds crazy, but a sleep tech wants to see you at your worst, so that they can recommend a treatment that is the best. However there are some things you will want to do in preparation for your test:

• Arrive shortly before your usual bedtime, approximately between 8 p.m. to 9 p.m. for an overnight study.
• Make sure you have already had dinner and are ready for bed.
• Bring your medications.
• Bring comfortable clothes that you normally sleep in.
• Bring your morning bathroom supplies.

What Happens During an Overnight Sleep Study?

When you arrive for your sleep study, you will be met by a registered polysomnographic technologist (RPSGT) who will be administering your sleep study. They will generally go over your paperwork, have you fill out any necessary forms, and review with you what the sleep study will entail. After collecting your health history as well as some vitals like your blood pressure, the tech will apply monitors to measure activity in your body as you sleep. This will normally include:

• Wires with small cup electrodes attached to your scalp with a conductive paste to measure brain activity. This lets the tech know if you are sleeping, and what stage of sleep you are in.
• Wire electrodes are taped to your face near the eyes and chin to show muscle activity. These electrodes are used to measure eye movements, which also give clues to sleep stages, as well as chin movements which can observe possible nocturnal teeth grinding as well as other sleep disorders related to muscle activity.
• 2 elastic belts around your chest and stomach to measure breathing effort.
• A nasal cannula (clear plastic tubing) and small heat monitor to measure all breathing activity.
• A wire electrode on each leg to measure body movement/muscle activity.
• A monitor taped to your finger to detect oxygen levels during the study.
• 2-3 lead EKG monitors to show heart rate and rhythm.
• A small  mic applied to your throat to detect snoring.

Once you have been hooked up to the various machines, the RSPGT will begin monitoring the data from another room. They will communicate with you via an intercom system and run through a series of tests to calibrate the equipment. When the calibrations are finalized you are encouraged to sleep.

Getting to Sleep during an In-lab Sleep Study

Being able to sleep comfortably outside of one's own bed while hooked up to a myriad of wires may seem an impossible feat. But it's really not. Rarely does a sleep study fail because the patient was unable to sleep. Even if you think that you didn't get any sleep during your overnight sleep study, you may be surprised to find that you slept much more than you realized. And even if you really didn't get a whole lot of sleep during your study, chances are you slept enough to obtain an adequate amount of data.

​What Happens After A Sleep Study?

In the morning, around 6-7 a.m., the sleep technician will wake you, remove your monitors, have you fill out some more paperwork and allow you to go home or to work. Most sleep clinics have facilities available for showering and getting ready in the morning so that you don't have to run home first to prepare for your day.

The RSPGT will not be able to share your results with you. Instead, the information is sent to your doctor or a sleep specialist for evaluation. Your doctor or sleep specialist will review the results of your sleep test as well as your medical history and sleep history to make a diagnosis.

Results from the sleep study often take a week to 10 days to get reviewed and finalized before you will be contacted with the results. At this point, if a sleep disorder was detected in the study, your doctor or sleep specialist will go over possible treatments for your condition.

I had a reader contact me on Messenger wondering if Dysautonomia is common in Fibromyalgia.  This surfaced memories from my own battle with my central nervous systems disorder and my neurologist.  You see I have many, too numerous to count, disorders of the autonomic nervous system that I am at odds when I speak to my specialist. 

"These recent symptoms seem to be more specifically related to dysautonomia.  Is there something I should be tested for?" I asked.

"No, you do not have an autonomic disorder, " he assures me.

I can tell you being up all night with night sweats and spine burning does not make me feel secure with that answer.  Nor does having liable blood pressure with heart irregularities make me feel any better.  

So What Is Dysautonomia?

Dysautonomia (or autonomic dysfunction) is any disease or malfunction of the autonomic nervous system (ANS). The autonomic nervous system controls a number of functions in the body, such as heart rate, blood pressure, digestive tract peristalsis, and sweating, amongst others. Dysfunction of the ANS can involve any of these functions.

A number of conditions are forms of dysautonomia: postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST), vasovagal syncope, pure autonomic failure, neurocardiogenic syncope (NCS), neurally mediated hypotension (NMH), orthostatic hypotension, orthostatic hypertension, autonomic instability, and a number of lesser-known disorders such as cerebral salt-wasting syndrome. Dysautonomia may occur as the result of other diseases, such as diabetes mellitus, multiple system atrophy (Shy-Drager syndrome), Guillain-Barré syndrome and a number of other conditions that may affect the nervous system.

Just taking a minute to peruse the above sources lets you know you are dealing with a life-threatening illness.  So, it is clear where many fibromyalgia suffers may get confused when noting such symptoms to their specialist.  

What Are the Symptoms of Dysautonomia?

The symptoms of dysautonomia are numerous and vary widely from person to person. Since dysautonomia is a full-body condition, a large number of symptoms may be present that can greatly alter a person’s quality of life. Each patient with dysautonomia is different—some are affected only mildly, while others are left completely bed-ridden and disabled.
​

• Excessive fatigue
• Excessive thirst (polydipsia)
• Lightheadedness, dizziness or vertigo
• Feelings of anxiety or panic (not mentally induced[citation needed])
• Rapid heart rate or slow heart rate
• Orthostatic hypotension, sometimes resulting in syncope (fainting)
• Gastroparesis (delayed gastric emptying)
• Headaches
• Mydriasis (abnormal dilation of the pupils)
• Salt cravings
• Constipation
• Pallor (unhealthy pale appearance)
• Diarrhea
• Nausea
• Acid reflux
• Visual disturbances
• Orthostatic hypotension
• Numbness
• Nerve pain
• Trouble breathing
• Chest pains

Many of us suffer from at least 75% of the symptoms labeled above.  Hence, it is understandable why we'd be concerned over ANS failure. Then again, it seems as if we all have a tad of any number of ANS disorders, yet, we are not labeled with the diagnosis, but just seem to exhibit varying degrees of symptoms.  

How Is It Diagnosed?

​Autonomic neuropathy is a possible complication of a number of diseases, and the tests you'll need depend on your symptoms and risk factors for autonomic neuropathy.

When you have known risk factors for autonomic neuropathy

If you have conditions that increase your risk of autonomic neuropathy, such as diabetes, and have symptoms of the condition, your doctor will perform a physical exam and ask about your symptoms.

If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.

When you don't have risk factors for autonomic neuropathy.

If you have symptoms of autonomic neuropathy but no risk factors, the diagnosis can be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.
Your doctor might recommend tests to evaluate autonomic functions, including:

• Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
• Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.
  A simpler test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
• Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
• Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through capsules placed on your forearm, upper and lower leg and foot, while a computer analyzes the response of your nerves and sweat glands. You might feel warmth or a tingling sensation during the test.
• Thermoregulatory sweat test. You're coated with a powder that changes color when you sweat. While lying in a chamber with a slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern might help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
• Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary signs and symptoms, a series of urine and bladder tests can evaluate bladder function.
• Ultrasound. If you have bladder signs and symptoms, your doctor might do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.

Treatment of autonomic neuropathy includes:

• Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to tightly control blood sugar to prevent autonomic neuropathy from progressing. About half of the time, no underlying cause for autonomic neuropathy is found.
• Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.

Digestive (gastrointestinal) symptoms
Your doctor may recommend:

• Diet changes. You might need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also might help. Slowly increase fiber to avoid gas and bloating.
• Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication can cause drowsiness and isn't advised for long-term use.
• Medications to ease constipation. Over-the-counter laxatives can help ease constipation. Ask your doctor how often you should use a laxative.
• Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines, and over-the-counter antidiarrheal medication might be helpful.

Urinary symptoms
Your doctor may suggest:

• Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
• Medication to help empty the bladder. Bethanechol (Duvoid) is a medication that helps ensure complete bladder emptying. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
• Urinary assistance (catheterization). A tube is guided through your urethra to empty your bladder.
• Medications that decrease an overactive bladder. These include tolterodine (Detrol), oxybutynin or similar medications. Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.

Sexual dysfunction
For men with erectile dysfunction, your doctor might recommend:

• Medications that enable erections. Drugs such as sildenafil (Viagra, Revatio), vardenafil (Levitra) or tadalafil (Adcirca, Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and changes in color vision.
  If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
• External vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.

For women with sexual symptoms, your doctor might recommend:

• Vaginal lubricants to decrease dryness and make sexual intercourse more comfortable and enjoyable.
• Flibanserin (Addyi) for premenopausal women with low sexual desire.

Heart rhythm and blood pressure symptoms
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor might prescribe:

• Medications to raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor might suggest fludrocortisone. This medication helps your body retain salt, which helps regulate your blood pressure.
  Other drugs that can help raise your blood pressure include midodrine (Orvaten) and pyridostigmine (Mestinon, Regonol). Droxidopa (Northera) also can help raise blood pressure. Midodrine and droxidopa can cause high blood pressure when lying down.
• Medication to regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if it goes too high with an activity level.
• A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high- fluid diet can help maintain your blood pressure. This is generally only recommended for severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs and shouldn't be used in patients with heart failure.

Sweating
If you sweat too much, your doctor might prescribe:

• A medication that decreases perspiration. Glycopyrrolate (Cuvposa, Robinul, Robinul Forte, others) can decrease sweating. Side effects can include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headache, loss of taste and drowsiness. Glycopyrrolate can also increase the risk of heat-related illness, such as heatstroke, from a reduced ability to sweat.
• Surgery to cut the nerves in the sweat glands. It's also possible to remove the sweat glands but only in small areas of increased sweating, such as the palms.

It’s common for fibromyalgia sufferers to experience at least one or more forms of dysautonomia syndrome. We know that with fibromyalgia, there is a dysfunction in the ANS. For many with fibromyalgia, it appears as a delayed and inflated response to stressful situations. The fibromyalgia sufferer may go through a stressful situation without releasing the stress hormones that are typically produced automatically.

Once the stressful encounter is over and the sufferer is able to relax, the release of those stress hormones is triggered. The sufferer is flooded with stress hormones and experiences the anxiety and energy that others felt during the stressful situation, only the sufferer experiences it to an extreme degree long after the stress has subsided. This delayed reaction may make it appear that there is no cause for the sudden onset of severe alarm and discomfort.

Because of this, scientists have identified multiple abnormalities in fibromyalgia, including problems in the central nervous system and the autonomic nervous system. Fibromyalgia can be a result of dysautonomia or dysautonomia may be a result of fibromyalgia, we don’t really know. But there seems to be sufficient evidence to correlate the two. If you have symptoms of dysautonomia, discuss it with your physician. Diagnosis needs to be made in order to explore possible treatments that will ease your symptoms and improve your health.

I week later, and the Lexiscan evaluated, I was back in the doctor's office deciphering my results. Pleasantly surprised, I was four pounds lighter!

I had run amok on the library internet resource grabbing and putting on hold all the available books on the Paleo diet.  I wanted to understand EVERYTHING concerning my new nutrient contents that I was ingesting were affecting my body.. Since my system is so hyper sensitive to change, I needed to try and prevent any backlash.    

There were some initial bumps.  Going grain free and very limited on carbs made me feel TOO energetic.  It was quite a dilemma to swallow since I am limited on carbs as it is.  I was shocked to feel these new electrical paths course through my body.  I filled up on many plumb sweet potatoes those first few days which satiated and made me feel comfortable and more sedate.  Surely, filling up on extra tubers wasn't going to have much effect on my weight.  But, I was tickled when I stepped on the scale to find two pounds gone the following morning.  The following day another two pounds.  Then over the rest of the week another two pound loss.  So, when I got to the doctor's office my six pounds turned into four loaded down with more clothes and sandals.  

"Great, you lost a few pounds," my cardiologist chimed.  

"Well, you told me to go on the Paleo.  Actually, this is the first time I had any substantial weight loss in ANYTHING I tried over the last seven years since being diagnosed." I retorted.  "Most importantly, I sleep less in the afternoon, and I'm noticing my pain levels have decreased significantly." 

There were other things flitting through my mind I didn't mention.  Like the first time I hooked my bra the following day - there wasn't uncomfortable shoulder pain.  Or, the fact I hadn't taken my omeprazole for four days because I haven't experienced any heartburn from GERD.  Then there's the fact that I hadn't woken with a headache since I started.  Also, I was taking pain medication less and less because I was forgetting to take it. Most importantly, my kids saw me up and around doing things around the house.  "Are you doing too much? Go lay down, " they'd say.  

"How was your Lexiscan? Looks like there were a few hiccups," he questioned.

"Better than I thought.  I was extremely nervous during the procedure, but I noticed the initial affect after the injection wasn't as horrible as I read on the Internet.  There was only a slight rise in heartbeat.  But, it was afterwards, as the drug was supposed to dissipate that I had issues.  My blood pressure kept climbing and climbing to 247/121.  They had to give me the antidote.  Then it slowly subsided, " I answered.

"Yes, I see.  Stay off the Internet.  Save yourself emotional trouble next time," he replied.

He then thoroughly explained my results.  Due to unwarranted and liable blood pressure I had Left Ventricular Hypertrophy (LVH).  Simply stated, the left side of my heart was enlarging because it had to work harder to keep blood flowing due to my hypertension. "Luckily you came in when you did," he added.

​Left ventricular hypertrophy

LVH is enlargement and thickening (hypertrophy) of the walls of your heart's main pumping chamber (left ventricle).

Left ventricular hypertrophy can develop in response to some factor — such as high blood pressure or a heart condition — that causes the left ventricle to work harder. As the workload increases, the muscle tissue in the chamber wall thickens, and sometimes the size of the chamber itself also increases. The enlarged heart muscle loses elasticity and eventually may fail to pump with as much force as needed.

Left ventricular hypertrophy is more common in people who have uncontrolled high blood pressure. But no matter what your blood pressure is, developing left ventricular hypertrophy puts you at higher risk of a heart attack and stroke.

Treating high blood pressure can help ease your symptoms and may reverse left ventricular hypertrophy.

Symptoms

Left ventricular hypertrophy usually develops gradually. You may experience no signs or symptoms, especially during the early stages of the condition.

As left ventricular hypertrophy progresses, you may experience:

• Shortness of breath
• Fatigue
• Chest pain, often after exercising
• Sensation of rapid, fluttering or pounding heartbeats (palpitations)
• Dizziness or fainting

When to see a doctor

Seek emergency care if:

• You feel chest pain that lasts more than a few minutes
• You have severe difficulty breathing
• You have severe lightheadedness or lose consciousness

If you experience mild shortness of breath or other symptoms, such as palpitations, see your doctor.

If you have high blood pressure or another condition that increases your risk of left ventricular hypertrophy, your doctor is likely to recommend regular appointments to monitor your heart. Even if you feel well, you need to have your blood pressure checked annually, or more often if you:

• Smoke
• Are overweight
• Have other conditions that increase the risk of high blood pressure

​
Causes

Left ventricular hypertrophy can occur when some factor makes your heart work harder than normal to pump blood to your body.

Factors that can cause your heart to work harder include:

• High blood pressure (hypertension). This is the most common cause of left ventricular hypertrophy. More than one-third of people show evidence of left ventricular hypertrophy at the time of their diagnosis with hypertension.
• Aortic valve stenosis. This disease is a narrowing of the aortic valve that separates the left ventricle from the large blood vessel leaving your heart (aorta). The narrowing of the aortic valve requires the left ventricle to work harder to pump blood into the aorta.
• Hypertrophic cardiomyopathy. This genetic disease occurs when the heart muscle becomes abnormally thick, even with completely normal blood pressure, making it harder for the heart to pump blood.
• Athletic training. Intense, prolonged endurance and strength training can cause the heart to adapt to handle the extra workload. It's unclear whether this athletic type of left ventricle hypertrophy can lead to stiffening of the heart muscle and disease.

Risk factors

In addition to hypertension and aortic valve stenosis, factors that increase your risk of left ventricular hypertrophy include:

• Age. Left ventricular hypertrophy is more common in older people.
• Weight. Being overweight increases your risk of high blood pressure and left ventricular hypertrophy.
• Family history. Certain genetic conditions are associated with developing left ventricular hypertrophy.
• Diabetes. Left ventricular hypertrophy has been found to be linked to a higher risk of diabetes.
• Race. African-Americans are at higher risk of left ventricular hypertrophy than are white people with similar blood pressure measurements.
• Sex. Women with hypertension are at higher risk of left ventricular hypertrophy than are men with similar blood pressure measurements.

Complications

Left ventricular hypertrophy changes the structure and working of the heart. The enlarged left ventricle can:

• Weaken
• Stiffen and lose elasticity, preventing the chamber from filling properly and increasing pressure in the heart
• Compress the chamber's blood vessels (coronary arteries) and restrict its supply of blood

As a result of these changes, complications of left ventricular hypertrophy include:

• Reduced blood supply to the heart
• Inability of the heart to pump enough blood to your body (heart failure)
• Abnormal heart rhythm (arrhythmia)
• Irregular, often rapid heartbeat (atrial fibrillation) that decreases blood flow to the body
• Insufficient supply of oxygen to the heart (ischemic heart disease)
• Stroke
• Sudden, unexpected loss of heart function, breathing and consciousness (sudden cardiac arrest)

Prevention

The best way to prevent left ventricular hypertrophy caused by high blood pressure is to maintain healthy blood pressure. To better manage your blood pressure:

• Monitor high blood pressure. Purchase a home blood pressure measuring device and check your blood pressure frequently. Schedule regular checkups with your doctor.
• Make time for physical activity. Regular physical activity helps to lower blood pressure and keep it at normal levels. Aim for 30 minutes of moderate physical activity most days of the week.
• Eat a healthy diet. Avoid foods that are high in saturated fat and salt, and eat more fruits and vegetables. Avoid alcoholic beverages or drink them in moderation.
• Quit smoking. Giving up smoking improves your overall health and prevents heart attacks.

"The weight has to come off, and the blood pressure needs to be below 130," he added.

"The extra BP medicine you gave me raises it sometimes for an hour," I questioned.

"I think it's a fluke because of your chemical sensitives.  Keep working on it.  Your BP is still TOO high," he exclaimed.  

"I get it.  I'm working on it.  I'm off  to a good start.  I think this diet may be the answer.  I feel different.  To be honest, some days not so much as it is a different nutrient composition I'm chewing every day.  But, on the whole something is happening.  I understand I need to lose the weight and make some significant lifestyle changes.  I've not been able to loose more than 4 lbs. in a month before.  This is shedding off amazingly fast.  And, I don't feel deprived.  Just sick of sweet potatoes LOL," I answered.  

"Good, glad to hear it.  I'm going to see you back in three months," he confirmed.  "Keep up the good work.  You're doing great!"

With all the tests completed and in tow, I stepped into my first appointment with my cardiologist feeling nervous and apprehensive.  Surely, this must be a mistake as I feel I take really good care of myself.

Within minutes I was hooked up to the office EKG.  There were murmurs as the staff recorded results, "Yes, that was noted on the 24 hour holster monitor, too."  Sadly, something was astray.  

The cardiologist arrived shortly afterwards and began analyzing my testing results - looking back to previous years testing, too, to piece this all together.  After several minutes he looked up at me and smiled and said, "Yes, this was good timing on your part.  You needed to see me now so that we can get things under control." I can't tell you it was a comforting statement, but at least I knew i wouldn't end up in the ER with a heart attack. 

We went over my recent blood levels.  "These are way too high!" he exclaimed.  "We need to get things under control. Have you tried low-carb eating?" 

"Well, yes, I don't eat many carbs at all to begin with," I attested. "In fact I have been working on more of a vegan approach, but it doesn't seem to be helping with weight reduction.  I've noticed I feel lethargic and steadily gaining a couple of pounds every few months."

"Have you heard of the Paleo diet? No grains?" he asked.

"Well, I barely eat a 1/4 cup with meals to begin with because of weight gain.  I try to round out with wholesome vegetables and good protein sources," I retorted.  "I don't see how eating even less is going to help."

He swiftly walked out of the room and brought back a pamphlet.  "Read this, try it.  See what happens.  You have to do something to take the weight off to stabilize your uncontrollable blood pressure." "You have a Left Bundle Branch Block. Your blood pressure is off the charts throughout the day and causing this. I am going to order a Lexiscan to see how extensive the damage is," he said.  

Left Bundle Branch Block (LBB)

Bundle branch block is a condition in which there's a delay or blockage along the pathway that electrical impulses travel to make your heart beat. It sometimes makes it harder for your heart to pump blood efficiently through your body.

The delay or blockage can occur on the pathway that sends electrical impulses either to the left or the right side of the bottom chambers (ventricles) of your heart.

Bundle branch block might not need treatment. When it does, treatment involves managing the health condition, such as heart disease, that caused bundle branch block.

In most people, bundle branch block doesn't cause symptoms. Some people with the condition don't know they have a bundle branch block.

Signs and symptoms in people who have them might include:

• Fainting (syncope)
• Feeling as if you're going to faint (presyncope)

"But I have severe chemical sensitivities!" I whined.

"We need to be PROACTIVE.  This is something that needs to be done so I can help you.  I can't see what's going on without this test.  You are an educator.  Trust me, I loved my teachers.  I take good care of them. I am going to do the same for you," he exclaimed.  "It's going to be OK."

I was soon whisked off to the scheduling desk in tears knowing that this is not going to be the greatest experience, and it will take numerous days to get well afterwards. 

Lexiscan

A Nuclear Sit Down Stress Test or Lexiscan stress test, or LEXI, is designed to evaluate the condition of your coronary arteries.  These are the arteries that supply the heart itself with blood. This type of stress test is given when the Cardiologist feels that you may not be able to walk to an appropriate level of exercise on a treadmill.  This may be due to: arthritis, poor conditioning, the use of certain blood pressure medications that prevent your heart rate from increasing with exercise,  or the use of devices like a pacemaker of defibrillator.

​Lexiscan is a prescription medication used in a cardiac nuclear stress test. It works by increasing blood flow in the coronary arteries. Lexiscan is given by IV in preparation for a myocardial perfusion imaging (MPI) test. This uses a special camera to take pictures of your heart, giving your doctor detailed information about blood flow into your heart.

Using a special type of imager, a small amount of radioactive tracer is injected into your blood before and after an injection of a medication called Lexiscan, and pictures are taken of your heart muscle.  Lexiscan replaces the physical act of exercise, and elicits the same response from your body that would occur if you were actually exercising. The pictures that are taken before and after the Lexiscan injection are then compared to each other, to see if there are any differences. Such differences in the pictures helps your cardiologist determine whether there are may be any major blockages in your arteries.  They can also see if there has been damage to the heart muscle after a heart attack.  It will also help them determine the best type of treatment you may need to correct any abnormal finding. Treatment options may include medications, dietary and lifestyle modification, or perhaps a cardiac procedure such as an angioplasty or coronary artery bypass surgery.

There are different reasons why your cardiologist may want you to have a LEXI and these may include:

• symptoms or signs suggestive of coronary artery disease (CAD) such as chest pain, shortness of breath
• significant risk factors for CAD such as smoking, high blood pressure, high cholesterol
• assessment of your condition after a cardiac procedure such as bypass surgery or coronary angioplasty
• clearance for certain surgeries that are determined to be of intermediate to high risk

​If your doctor recommends a stress test with Lexiscan, it may reassure you to know that it's a noninvasive test, meaning it doesn't involve a surgical procedure.

Here's how it works:

• You'll be awake the entire time, and either lying down or sitting up in a chair. Your heart rhythm, blood pressure, and oxygen levels will be monitored during the test.
• A catheter (small needle) is placed in a vein in your arm. Lexiscan is injected through the catheter into your bloodstream for about 10 seconds, followed immediately by a saline solution to clear the intravenous (IV) line. Lexiscan dilates the coronary arteries to allow increased blood flow to the heart.
• 10 to 20 seconds after the saline solution, a small dose of radioactive isotope imaging tracer material is injected into the catheter.
• After the tracer is absorbed in your system and distributed in your arteries, a special camera will take detailed pictures of your heart. The pictures will show how well blood flows into your heart and if there are any areas of blockage. While you lie on your back with your arms above your head, the camera will take pictures for about 20 to 40 minutes.
• One set of images will be taken when Lexiscan is active in your system, and a second set of images will be taken when you're considered at rest.

​
The receptionist at the scheduling desk was well-informed and supportive.  "No worries," she stated.  "You can call our nuclear department with any questions.  They will walk you through everything."

I began to leaf through the pamphlet "Robb Wolf's Paleo Diet Quick Start Guide".  Have I been going about it all wrong?  I know a vegan diet is healthy for many individuals.  I've seen the results from readers here.  But, we are all wired differently.  Maybe I am not seeing the vegan results as others because my body does not respond well to grains.  Is this a possibility?  I am always willing to go full-force when trying anything new.  I made a mental note to pick up Paleo living books from the library along with Robb Wolff's The Paleo Solution. I had a week until my Lexiscan - let's see what happens.  I'm game for anything at this point.  

After an abnormal EKG, a referral was sent over to my cardiologist which entailed a 24-hour holster monitor first.  As I was calling to schedule my specialist appointment, the receptionist quickly set in place a holster monitor set-up appointment so that my doctor would have a variety of results before I even stepped into his office.  

​A Holter monitor is a small, battery-powered medical device that measures your heart’s activity, such as rate and rhythm. Your doctor may ask you to use one if they need more information about how your heart functions than a routine electrocardiogram (EKG) can give them.

Twenty-four hour Holter monitoring is a continuous test to record your heart’s rate and rhythm for 24 hours. You wear the Holter monitor for 12 to 48 hours as you go about your normal daily routine. This device has electrodes and electrical leads exactly like a regular EKG, but it has fewer leads. It can pick up not only your heart’s rate and rhythm but also when you feel chest pains or exhibit symptoms of an irregular heartbeat, or arrhythmia.

Holter monitor testing is also sometimes called ambulatory electrocardiography. There are other types of devices that can be used to measure heart activity for longer periods of time.

Uses for Holter monitoring

An EKG is a medical test that’s used to measure your heart rate and rhythm. It’s also used to look for other abnormalities that may affect normal heart function. During an EKG, electrodes are placed on your chest to check your heart’s rhythm. You may experience heart rhythm irregularities that don’t show up at the time the EKG is done because you’re only hooked up to the machine for a very brief amount of time.

Abnormal heart rhythms and other types of cardiac symptoms can come and go. Monitoring for a longer period of time is necessary to record these events. The Holter monitor lets your doctor see how your heart functions on a long-term basis. The recordings made by the monitor help your doctor determine if your heart is getting enough oxygen or if the electrical impulses in the heart are delayed or early. These irregular impulses may be referred to as arrhythmias or abnormal heart rhythms.

If you’re already being treated for heart problems, wearing your monitor can help your doctor determine if your medicine is working or if changes need to be made. It can also help them to see why you might be experiencing other symptoms of irregular heartbeat, such as dizziness, faintness, or feeling like your heart is racing or skipping a beat.

How it works

The Holter monitor is small. It’s slightly larger than a deck of playing cards. Several leads, or wires, are attached to the monitor. The leads connect to electrodes that are placed on the skin of your chest with a glue-like gel. The metal electrodes conduct your heart’s activity through the wires and into the Holter monitor, where it’s recorded.

You wear a small pouch around your neck that holds the monitor itself. It’s important to keep the monitor close to your body during the testing period to make sure the readings are accurate. Your doctor will show you how to reattach electrodes if they become loose or fall off during the testing period.

You’ll get instructions that explain how to take care of your monitor and what not to do while you’re wearing it. It’s important to avoid bathing, showering, and swimming while you’re wearing the monitor.
You’re encouraged to participate in your normal activities during the 24-hour Holter test. You’ll be directed to record your activities in a notebook. This helps your doctor determine if changes in heart activity are related to your behaviors and movements.

Wearing the Holter monitor itself has no risks involved. However, the tape or adhesives that attach the electrodes to your skin can cause mild skin irritation in some people. Make sure to tell the technician that attaches your monitor if you’re allergic to any tapes or adhesives.

A 24-hour Holter monitor test is painless. However, be sure to record any chest pain, rapid heartbeat, or other cardiac symptoms you have during the testing period.

Accuracy of testing

Keep the Holter monitor dry to ensure it functions properly. Take a bath or shower before your appointment to have the monitor fitted and don’t apply any lotions or creams. Avoid activities that might lead to the monitor getting wet.

Magnetic and electrical fields may interfere with the function of the Holter monitor. Avoid areas of high voltage while wearing the monitor.

In an event where misreadings or false-positives do occur, the Holter may need to be applied again.

Understanding the results

After the recommended testing time frame has passed, you’ll return to your doctor’s office to have the Holter monitor removed. Your doctor will read your activity journal and analyze the results of the monitor. Depending on the results of the test, you may need to undergo further testing before a diagnosis is made.

The Holter monitor may reveal that your medicine isn’t working or your dosage needs to be altered if you’re already taking medication for an abnormal heart rhythm. It’s especially useful in detecting abnormal heart rhythms that are painless and unknown to you.

Wearing a Holter monitor is painless and one of the best ways to identify potential heart problems or other issues. - Healtline

Wearing the Holster Monitor was a bit strange and sleeping was a bit cumbersome.  But, compared to the monitor of seven years ago they have made some advances!  This one was much lighter and easier to complete daily living tasks.  Monitor has been returned, and I now await the results.